lOMoARcPSD|26582732
Nurs 4111—adult health ii
Fall 2025
Final exam blueprint*
Clinical assessment: non-hodgkin disease o this is a type of lymphoma o it is an abnormal
proliferation of lymphocytes that affects the blood, bone marrow, tonsils, spleen, and lymph nodes
o Assessment – we are concerned with bleeding and infection, the hallmark of hodgkin lymphoma
is reed-sternberg cells, with non-hodgkin lymphoma we are see drenching night sweat, fever,
weight loss
o Clinical manifestations: fever, malaise, fatigue, weakness, night sweats, loss of appetite,
significant weight loss, anemia, thrombocytopenia, may see an enlarged spleen or lymph nodes
or liver
Safety
Neutropenia
o If a patient has severe neutropenia (neutrophil count <500) chemotherapy must be stopped. If the
patient has a low but not severe neutrophil count they can administer filgrastim (wbc growth
factor) and continue the chemotherapy.
o These individuals often have severe infections and are unresponsive to antibiotic therapy o wbc
and differential are used to evaluate the effectiveness of therapy
▪ normal wbc range is 5000-10000 in men and 4500-11000 in women o it
is commonly caused by chemotherapy
o No fresh flowers or plants, no fresh veggies or fruits allowed – risk of bacteria o meticulous hand
hygiene education for client, family, visitors, and staff o fluids should be encouraged
o These patients are vulnerable to infection – so no contract with individuals with known infections
and invasive measures such as an indwelling catheter should be avoided
o Monitor for sore throat, low grade fever is a big deal, use mask, avoid large crowds, and limit
visitors.
Chemotherapy
o Height and weight are important to consider for medication administration and should be
monitored closely (weight can fluctuate between 12-24lbs in a 24-hour period)
o Anorexia, fatigue, and a low-normal wbc count are expected effects of chemotherapy o treatment
with antiemetics one hour before chemotherapy and encouraging small frequent meals may help
with nausea
o Assess patency of iv before administration o infiltration can cause necrosis of tissue within 10-15
minutes (chemo is a vesicant) o many drugs are irritants that can cause phlebitis and sclerosis
o Ppe should be used for chemotherapy administration o specific to the type of chemo, route of
administration, and hospital protocols radiation
o There are three types of radiation: gamma, betta, and ionizing and three modes: external beam,
brachytherapy (internal radiation via seeds) and systemic radioisotope (given po/injection for
thyroid/prostate cancers)
o Safety considerations:
o External beam/teletherapy
▪ nurse will wear lead and will not be in the room o
internal beam/brachytherapy
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, *
▪ unsealed a
● Body waste can be hazardous for up to 48 hours after they get treated
▪ sealed
● Need to be 6 feet away
o Private room, caution sign on the door, minimize nursing exposure, dosimeter badge, alara (as low as
reasonably possible – total 30 mins per shift)
o Systemic radioisotope radiation therapy causes you to radiate for 2-3 days after administration o these
patients can expose others more easily
o Radiation can be excreted through urine, saliva, and other body fluids for 2-3 days after administration
o Education: avoid pregnant women and children, sleep alone, don’t share hygiene products and utensils
encourage fluid intake (to help the kidneys process all types/to flush out residue radiation), no walking
around, diet should be high in protein to promote wound healing
o Skin care: use mild soap, non-perfumed lotion, aloe vera gel/cream, don’t swim in salt/chlorinated pools,
avoid sun exposure, observe the area daily
Nursing considerations/interventions/teaching
Laryngectomy
o The client should be in a semi-fowler’s or fowler position to maintain a patent airway and minimize edema
o education: teach the client how to care for and protect stoma to avoid infection - should avoid people
with infections, avoid swimming, and protect when showering - increase humidity in the home, and wear
highcollared clothing to protect the stoma
o Fluid intake should be increased to 3000ml/day to keep secretions thin
o Nursing considerations include respiratory status, nutrition, potential trach, and consider trying to
communicate with a white board
o Radiation therapy of the larynx considerations o encourage fluids o frequent oral rinsing with non-
alcohol based mouthwashes o they can use sunscreen and lotions just not right before radiation o neck
bleeding is indicative of a possible carotid artery rupture .
Chemotherapy
Myelosuppression
o Common side effect of chemotherapy
o This disease suppresses the bone marrow’s ability to make new blood cells o leukemia, lymphoma, and
multiple myeloma all affect your bone marrow o nursing considerations: monitor for fever, administer
antibiotics as prescribed, and:
● Avoid use of suppositories, enemas, and rectal temperatures,
● Monitor for signs of anemia and institute neutropenic/bleeding precautions
as needed o wbcs are affected most acutely, onset of anemia 3-4 months after
initiation post
infusion care
Multiple myeloma (aka kahler disease)
o Malignant proliferation of plasma cells in bone marrow that produce an abnormal antibody (myeloma
protein or the bence jones protein)
o Causes decreased production of antibodies (concern for opportunistic infections) and increased uric acid
and increased serum calcium which can lead to kidney failure o high levels of calcium in the blood
mean less calcium in the bones which puts the patient at risk for pathologic fractures, kidney
stones, dysrhythmias, and seizures
o Nursing considerations: patients should have frequent temperature checks, skin assessment, and strict i&os.
Encourage weight bearing exercises and ambulation.
Nutrition o think safety- they have an increased risk for aspiration o should have a bedside
swallow evaluation before determining diet o high protein, high calorie diet (cancer depletes
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
muscle mass) o avoid extreme temp foods, rough, irritating foods that might upset gi, spicy
foods o taste will be altered o encourage supplements like ensure o refer to a nutrition
counselor o may need to weight the patient twice weekly to monitor weight (daily weights
best) o monitor albumin levels (controls osmotic regulation)
o At risk for anorexia - decreased appetite, harder to eat, loss of taste
Tumor lysis syndrome
o Massive cell destruction that causes the cells to release all their components into the bloodstream o results
in a release of k, phosphate, dna & rna ▪ which then causes a
● massive metabolic response and complications
o Hallmark will be hyperuricemia- increase in uric acid, hyperphosphatemia, hypocalcemia, hyperkalemia o
leads to increased lactic acid
o Side effects include extreme muscle cramping, diarrhea, n/v o starts within 24-48 hours of receiving
chemo o nursing considerations: prepare for iv hydration, strict i&o, watch urine output closely,
administer sodium bicarb to combat these massive components, patient will become very acidic, alopurinol
(given prophylactically to decrease uric acid)
Lymphedema
o Maintain fluid and electrolyte balance, administer diuretics, and provide a low-salt diet for severe
lymphedema
o After a mastectomy the patient should be positioned in a semi-fowler’s position with the affected arm
elevated above the level of the heart to promote drainage and prevent lymphedema, simple arm exercise
should be encouraged, compression sleeve will assist in improving lymphatic flow to heart,
o No venipuncture, injections, or blood pressure on affected side o male impotence may occur due to lower
extremity lymphedema o can cause cardiac arrhythmias and clogging of renal tubules o occurs 24-48
hours after chemotherapy is initiated o get rid of excess in blood via iv fluids and oral hydration
o Glucose/insulin to treat hyperkalemia and alopurinol to decrease uric acid levels o no deodorant on
affected side
Gi
Clinical assessment/laboratory considerations
Cirrhosis
o Caused by medication, blunt force trauma, liver lac, chronic alcoholism o laboratory considerations o
monitor albumin level - if the albumin level is decreased the patient is a risk for the development of edema
o Monitor ammonia level - if increased the patient is at risk for hepatic encephalopathy
▪ lactulose will decrease ammonia levels
o Liver impairment usually leads to secondary bleeding disorders so monitor coagulation studies
(pt, ptt, inr), administer blood products, and maintain ng tube
o Folic acid and thiamine are the most important supplements
o Interventions: liver congestion can turn into pulmonary congestion so keep the head of the bed elevated,
avoid harsh soaps, and moisturize, and restrict sodium and fluids
o Assessment: monitor i&o, monitor loc, weigh & measure abdominal girth, ascites, esophageal varices
(caused by pulmonary fluid backing up into other systems), coagulation defects (dic, platelet dysfunction,
chronic anemia) portal systemic (hepatic) encephalopathy, hepatorenal syndrome (kidney failure secondary
to liver disease),
o Treatment: paracentesis (to draw fluid out) o position: lean over bedside table o types:
● Cardiac**
Downloaded by NELSON KIIRU ()
Nurs 4111—adult health ii
Fall 2025
Final exam blueprint*
Clinical assessment: non-hodgkin disease o this is a type of lymphoma o it is an abnormal
proliferation of lymphocytes that affects the blood, bone marrow, tonsils, spleen, and lymph nodes
o Assessment – we are concerned with bleeding and infection, the hallmark of hodgkin lymphoma
is reed-sternberg cells, with non-hodgkin lymphoma we are see drenching night sweat, fever,
weight loss
o Clinical manifestations: fever, malaise, fatigue, weakness, night sweats, loss of appetite,
significant weight loss, anemia, thrombocytopenia, may see an enlarged spleen or lymph nodes
or liver
Safety
Neutropenia
o If a patient has severe neutropenia (neutrophil count <500) chemotherapy must be stopped. If the
patient has a low but not severe neutrophil count they can administer filgrastim (wbc growth
factor) and continue the chemotherapy.
o These individuals often have severe infections and are unresponsive to antibiotic therapy o wbc
and differential are used to evaluate the effectiveness of therapy
▪ normal wbc range is 5000-10000 in men and 4500-11000 in women o it
is commonly caused by chemotherapy
o No fresh flowers or plants, no fresh veggies or fruits allowed – risk of bacteria o meticulous hand
hygiene education for client, family, visitors, and staff o fluids should be encouraged
o These patients are vulnerable to infection – so no contract with individuals with known infections
and invasive measures such as an indwelling catheter should be avoided
o Monitor for sore throat, low grade fever is a big deal, use mask, avoid large crowds, and limit
visitors.
Chemotherapy
o Height and weight are important to consider for medication administration and should be
monitored closely (weight can fluctuate between 12-24lbs in a 24-hour period)
o Anorexia, fatigue, and a low-normal wbc count are expected effects of chemotherapy o treatment
with antiemetics one hour before chemotherapy and encouraging small frequent meals may help
with nausea
o Assess patency of iv before administration o infiltration can cause necrosis of tissue within 10-15
minutes (chemo is a vesicant) o many drugs are irritants that can cause phlebitis and sclerosis
o Ppe should be used for chemotherapy administration o specific to the type of chemo, route of
administration, and hospital protocols radiation
o There are three types of radiation: gamma, betta, and ionizing and three modes: external beam,
brachytherapy (internal radiation via seeds) and systemic radioisotope (given po/injection for
thyroid/prostate cancers)
o Safety considerations:
o External beam/teletherapy
▪ nurse will wear lead and will not be in the room o
internal beam/brachytherapy
Downloaded by NELSON KIIRU ()
, *
▪ unsealed a
● Body waste can be hazardous for up to 48 hours after they get treated
▪ sealed
● Need to be 6 feet away
o Private room, caution sign on the door, minimize nursing exposure, dosimeter badge, alara (as low as
reasonably possible – total 30 mins per shift)
o Systemic radioisotope radiation therapy causes you to radiate for 2-3 days after administration o these
patients can expose others more easily
o Radiation can be excreted through urine, saliva, and other body fluids for 2-3 days after administration
o Education: avoid pregnant women and children, sleep alone, don’t share hygiene products and utensils
encourage fluid intake (to help the kidneys process all types/to flush out residue radiation), no walking
around, diet should be high in protein to promote wound healing
o Skin care: use mild soap, non-perfumed lotion, aloe vera gel/cream, don’t swim in salt/chlorinated pools,
avoid sun exposure, observe the area daily
Nursing considerations/interventions/teaching
Laryngectomy
o The client should be in a semi-fowler’s or fowler position to maintain a patent airway and minimize edema
o education: teach the client how to care for and protect stoma to avoid infection - should avoid people
with infections, avoid swimming, and protect when showering - increase humidity in the home, and wear
highcollared clothing to protect the stoma
o Fluid intake should be increased to 3000ml/day to keep secretions thin
o Nursing considerations include respiratory status, nutrition, potential trach, and consider trying to
communicate with a white board
o Radiation therapy of the larynx considerations o encourage fluids o frequent oral rinsing with non-
alcohol based mouthwashes o they can use sunscreen and lotions just not right before radiation o neck
bleeding is indicative of a possible carotid artery rupture .
Chemotherapy
Myelosuppression
o Common side effect of chemotherapy
o This disease suppresses the bone marrow’s ability to make new blood cells o leukemia, lymphoma, and
multiple myeloma all affect your bone marrow o nursing considerations: monitor for fever, administer
antibiotics as prescribed, and:
● Avoid use of suppositories, enemas, and rectal temperatures,
● Monitor for signs of anemia and institute neutropenic/bleeding precautions
as needed o wbcs are affected most acutely, onset of anemia 3-4 months after
initiation post
infusion care
Multiple myeloma (aka kahler disease)
o Malignant proliferation of plasma cells in bone marrow that produce an abnormal antibody (myeloma
protein or the bence jones protein)
o Causes decreased production of antibodies (concern for opportunistic infections) and increased uric acid
and increased serum calcium which can lead to kidney failure o high levels of calcium in the blood
mean less calcium in the bones which puts the patient at risk for pathologic fractures, kidney
stones, dysrhythmias, and seizures
o Nursing considerations: patients should have frequent temperature checks, skin assessment, and strict i&os.
Encourage weight bearing exercises and ambulation.
Nutrition o think safety- they have an increased risk for aspiration o should have a bedside
swallow evaluation before determining diet o high protein, high calorie diet (cancer depletes
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
muscle mass) o avoid extreme temp foods, rough, irritating foods that might upset gi, spicy
foods o taste will be altered o encourage supplements like ensure o refer to a nutrition
counselor o may need to weight the patient twice weekly to monitor weight (daily weights
best) o monitor albumin levels (controls osmotic regulation)
o At risk for anorexia - decreased appetite, harder to eat, loss of taste
Tumor lysis syndrome
o Massive cell destruction that causes the cells to release all their components into the bloodstream o results
in a release of k, phosphate, dna & rna ▪ which then causes a
● massive metabolic response and complications
o Hallmark will be hyperuricemia- increase in uric acid, hyperphosphatemia, hypocalcemia, hyperkalemia o
leads to increased lactic acid
o Side effects include extreme muscle cramping, diarrhea, n/v o starts within 24-48 hours of receiving
chemo o nursing considerations: prepare for iv hydration, strict i&o, watch urine output closely,
administer sodium bicarb to combat these massive components, patient will become very acidic, alopurinol
(given prophylactically to decrease uric acid)
Lymphedema
o Maintain fluid and electrolyte balance, administer diuretics, and provide a low-salt diet for severe
lymphedema
o After a mastectomy the patient should be positioned in a semi-fowler’s position with the affected arm
elevated above the level of the heart to promote drainage and prevent lymphedema, simple arm exercise
should be encouraged, compression sleeve will assist in improving lymphatic flow to heart,
o No venipuncture, injections, or blood pressure on affected side o male impotence may occur due to lower
extremity lymphedema o can cause cardiac arrhythmias and clogging of renal tubules o occurs 24-48
hours after chemotherapy is initiated o get rid of excess in blood via iv fluids and oral hydration
o Glucose/insulin to treat hyperkalemia and alopurinol to decrease uric acid levels o no deodorant on
affected side
Gi
Clinical assessment/laboratory considerations
Cirrhosis
o Caused by medication, blunt force trauma, liver lac, chronic alcoholism o laboratory considerations o
monitor albumin level - if the albumin level is decreased the patient is a risk for the development of edema
o Monitor ammonia level - if increased the patient is at risk for hepatic encephalopathy
▪ lactulose will decrease ammonia levels
o Liver impairment usually leads to secondary bleeding disorders so monitor coagulation studies
(pt, ptt, inr), administer blood products, and maintain ng tube
o Folic acid and thiamine are the most important supplements
o Interventions: liver congestion can turn into pulmonary congestion so keep the head of the bed elevated,
avoid harsh soaps, and moisturize, and restrict sodium and fluids
o Assessment: monitor i&o, monitor loc, weigh & measure abdominal girth, ascites, esophageal varices
(caused by pulmonary fluid backing up into other systems), coagulation defects (dic, platelet dysfunction,
chronic anemia) portal systemic (hepatic) encephalopathy, hepatorenal syndrome (kidney failure secondary
to liver disease),
o Treatment: paracentesis (to draw fluid out) o position: lean over bedside table o types:
● Cardiac**
Downloaded by NELSON KIIRU ()
