NUR 445 Exam 5 UPDATED ACTUAL Questions and CORRECT Answers
- 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,
What is TLS? s/s? 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 Rapidly proliferative ones such as leukemia and lymphoma
compared to other cancers?
- 3 L IV fluids daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium polystyrene (kayexalate),
What is the treatment for TLS?
phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
- disseminated intravascular coagulation
- complication of septic SHOCK
- Clotting phase: widespread thrombi formation in capillaries cause hypoxia and
What is DIC? 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.
, - Treat underlying cause (sepsis, cardiac arrest, trauma, obstetric complications,
cancer, allergic reaction)
- Blood transfusion
- Admin platelets and clotting factors
How is DIC treated? - 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
- Immune mediated heparin induced clotting disorder where platelets are depleted
because of platelet consumption by more clots forming
What is HIT? when does it occurs? risk - Occurs 5-14 days after first administration
factors? Dx? - 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)
STOP HEPARIN
How is HIT treated? Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
Soft bristle toothbrush
NO FLOSS
What are some bleeding precautions we Electric razor for shaving
would implement for patients with Stool softeners
DIC/HIT? Avoid IM, ART lines, Peripheral lab draws
No blowing nose
*contact Dr for persistent bleeding including unrelenting epistaxis*
How long should platelets be transfused 15-30 minutes
for?
stop heparin
How is heparin overdose treated? admin protamine sulfate
bleeding precautions
What type of cancer can affect calcium metastasized to the bone
levels?
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).
what is ITP?
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
M: muscle weakness and mental status changes (confusion, lethargy, seizures, coma)
U: urine oliguria or anuria
R: respiratory distress
s/s of hyperkalemia: MURDER D: decreased cardiac contractility
E: EKG changes (peaked T waves, small P waves, widening QRS complex leading to
absent P wave and sinusoidal waves)
R: reflexes hyper or hypo
- 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,
What is TLS? s/s? 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 Rapidly proliferative ones such as leukemia and lymphoma
compared to other cancers?
- 3 L IV fluids daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium polystyrene (kayexalate),
What is the treatment for TLS?
phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
- disseminated intravascular coagulation
- complication of septic SHOCK
- Clotting phase: widespread thrombi formation in capillaries cause hypoxia and
What is DIC? 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.
, - Treat underlying cause (sepsis, cardiac arrest, trauma, obstetric complications,
cancer, allergic reaction)
- Blood transfusion
- Admin platelets and clotting factors
How is DIC treated? - 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
- Immune mediated heparin induced clotting disorder where platelets are depleted
because of platelet consumption by more clots forming
What is HIT? when does it occurs? risk - Occurs 5-14 days after first administration
factors? Dx? - 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)
STOP HEPARIN
How is HIT treated? Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
Soft bristle toothbrush
NO FLOSS
What are some bleeding precautions we Electric razor for shaving
would implement for patients with Stool softeners
DIC/HIT? Avoid IM, ART lines, Peripheral lab draws
No blowing nose
*contact Dr for persistent bleeding including unrelenting epistaxis*
How long should platelets be transfused 15-30 minutes
for?
stop heparin
How is heparin overdose treated? admin protamine sulfate
bleeding precautions
What type of cancer can affect calcium metastasized to the bone
levels?
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).
what is ITP?
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
M: muscle weakness and mental status changes (confusion, lethargy, seizures, coma)
U: urine oliguria or anuria
R: respiratory distress
s/s of hyperkalemia: MURDER D: decreased cardiac contractility
E: EKG changes (peaked T waves, small P waves, widening QRS complex leading to
absent P wave and sinusoidal waves)
R: reflexes hyper or hypo
