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Nur 431- Exam 4 Questions with Correct Answers
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Nur 431- Exam 4 Questions with Correct Answers
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Nur 431- Exam 4 Questions with CorrectAnswers
ALL - Answer-•cancer of bone marrow & blood
•risk factors:
🔸exposure to radiation (including past cancer treatment)
🔸some genetic disorders
🔸sibling with ALL
🔸more common in children
•symptoms
🔸first symptoms are usually flu-like but don't improve with time
🔸weakness
🔸fever
🔸fatigue
🔸pale skin
🔸swollen lymph nodes
🔸shortness of breath
🔸bleeding from gums
🔸bruising
🔸frequent nosebleeds
🔸frequent infections
🔸bone pain
Typical Medical Management of ALL - Answer-•Chemo is common
•3 stages of chemo treatment
1. Induction⭐️
-aggressive
-seeks to destroy leukemic cells in tissues, peripheral blood, & bone marrow
-patient may become critically ill b/c bone marrow is severely depressed
2. Post- Induction
-high dose chemo that lasts several months= intensification
-consolidation starts after remission is achieved; purpose is to eliminate rest of
leukemia cells
3. Maintenance
-includes lower doses of therapy given every 3-4 weeks for a prolonged period of time
•combination therapy is the mainstay treatment because it decreases drug resistance,
maximizes drug toxicity, & interrupts cell growth at multiple points in cell life cycle
•radiation therapy may be used to prepare patient for BMT
•corticosteroids may also be used
AML (acute myelogenous leukemia)⭐️ - Answer-•can progress quickly if not treated
•patient may have serious infections & abnormal bleeding from onset
,CML (chronic myelogenous leukemia) - Answer-•chronic phase can last several years &
can be well controlled with treatment
•chronic phase eventually progresses to accelerated phase
•treatment in accelerated phase needs to be more aggressive
Myelodysplastic Syndrome - Answer-•blood forming cells in bone marrow are damaged
which leads to low numbers or 1+ types of blood cells
•abnormal cells die sooner than normal cells which leaves the person with low blood
counts
Multiple Myeloma - Answer-•involves malignant plasma cells
•characterized by low blood counts, bone & calcium problems, infections, & kidney
problems
Immune Thrombocytopenia - Answer-•antibodies produced by immune system attach
themselves to platelets marking them for destruction by the spleen
•main therapies include:
🔸corticosteroids
🔸IV immunoglobulin
🔸possible splenectomy
Thrombotic Thrombocyotpenia Purpura⭐️ - Answer-•lack of activity of plasma enzyme
which causes blood to clot in body organs such as brain, kidneys, & heart
•these clits lead to decreased platelets in blood & issues like internal bleeding, bruising,
& slow clotting when injured
•best treated by identifying & treating underlying cause
Heparin Induced Thrombocytopenia - Answer-•develops 5-10 days after beginning
therapy
•treated by discontinuing heparin
•patient should NOT use heparin again
Chemotherapy Induced Thrombocytopenia - Answer-•myelosuppression is an extremely
common toxicity of chemo
•chemo attacks platelets, just like other cells
•treatment may include thrombopoietic specific cytokine (TPO)
Causes of Thrombocytopenia & Education - Answer-•chemo
•ginger could contribute to low platelets
•educate on signs & symptoms of bleeding:
🔸tarry stools⭐️
🔸coffee ground emesis
🔸nose bleeds
🔸excessive bruising
🔸sudden weakness in arm or leg
🔸small, red or purple spots on skin
, 🔸headache
🔸changes in vision
🔸confusion
Clinical Manifestations of Thrombocytopenia⭐️ - Answer-•many patients are
asymptomatic
•most common symptom is bleeding
🔸epitaxis
🔸gingival bleeding
🔸petechiae
🔸Purpura (bruising)
🔸superficial ecchymosis (large purple lesions)
•major complication is hemorrhage
Disseminated Intra-Vascular Coagulation (DIC)⭐️
- Answer-•ALWAYS results from
another condition
•clinical manifestations
🔸changes in mental status
🔸petechiae
🔸venipuncture site bleeding
🔸tachycardia
🔸tachypnea
Medical Management of DIC - Answer-•timely diagnosis is critical!
-early signs of bleeding:
🔸petechiae
🔸oozing at IV site
🔸pain
🔸⬆️ HR
🔸changes in mental status
🔸increasing abdominal girth
•focus is treating the cause & controlling bleeding
•monitor need for blood products by assessing lab levels (PT, PTT, platelets)⭐️
•oxygen therapy to correct tachypnea
Sickle Cell Anemia - Answer-•inherited autosomal recessive disorder
•Hgb gets rigid, sticky, & crescent shaped
•identified during infancy or early childhood
•sickling episode
🔸triggered by low O2 in blood (r/t viral infection, high altitude, dehydration, stress,
surgery, blood loss)
🔸reversible by reoxygenation
•sickle cell crisis
🔸sudden & persistent for days to weeks
🔸frequency, extent, & severity of episodes are highly variable & unpredictable
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