Lymphomas
Lymphomas are cancers of the lymph tissue with overgrowth of lymphocytes (unlike stem cell issues like leukemia). Solid tumors grow in lymph nodes throughout the body. Hodgkin's lymphoma differs from nonhodgkin's lymphoma in what way?
a. Large and painless lymph nodesb. HL has Reed-Sternberg cells and spreads predictably from one group of notes to the next.
c. Night sweats
d. Unexplained weight loss
B. HL has Reed-Sternberg cells and spreads predictably from one group of notes to the next.
All lymphomas typically have:
Large, painless lymph notes
night sweats
unexplained weight loss (>10% body weight)
Temp > 101.5
Enlarged spleen (and possibly liver)
What symptoms would the nurse expect to see in a client with Idiopathic thrombocytopenic purpura (ITP)?
a. distended jugular veins
b. petechiae and ecchymosis
c. hyper reflexive muscles
d. Elevated H&H
Idiopathic thrombocytopenic purpura (ITP) occurs when the body attacks/destroys its own functioning platelets.
Low platelets lead to bleeding. So, the nurse would expect to see ecchymosis and petechiae.
A low H&H may result due to bleeding.
The other options are not related.
A toddler with hemophilia fell onto their knees into rocks while running. Both knees have scrapes and bruises forming immediately. What should the parents do? Select all that apply.
a. Apply pressure for 15 minutes or until bleeding stops
b. Apply a heat pack
c. Immobilize the knee if possible
d. Pour alcohol onto the abrasions
e.Immediately go to the emergency room
A, C
Apply pressure for superficial abrasions, apply ice for vasoconstriction, and immoblize the area (decreases blood flow to area).
Avoid heat as this will cause vasodilation and increase bleeding. Do not use alcohol. Emergency care doesn't need to be sought unless the bleeding continues or the injury was more severe.
A nurse is preparing to administer Fresh Frozen Plasma. Which of the following should the nurse do for administration? Select all that apply.
a. Ensure consent is signed
b. Administer immediately after thawing
c. Ensure ABO compatibility
d. Infuse over 4 hours
e. Use regular, non filtered tubing
A, B, C
Should be administered immediately after thawing so clotting factors are still active/working
Should be infused rapidly 200mL over 30-60 min
Filtered tubing should be utilized
A client with Hodgkin's Lymphoma requires radiation, including the area of the inguinal and groin area. Which of the following topics should the nurse ensure the patient has considered before beginning this therapy?
a. not obtaining any tattoos in these areas during treatment
b. No scars are in these areas
c. If the client has considered/completed sperm banking.
d. If the client has any mesh from an inguinal hernia repair.
C. Radiation to the inguinal/groin area can result in permanent sterility. Sperm banking should be considered for the male patient.
Chemotherapy may also be required.
Women may also consider egg or embryo banking. Women may not be able to carry a child to term if the uterus is scarred/damaged and unable to stretch.
Consider...
Nursing interventions for radiation and chemo
A client has ITP. Which of the following orders would the nurse question?
a. Platelet transfusion if platelets < 10,000
b. immunosuppressants administration
c. clopidigrel administration
d. Fall precautions
ITP has low platelets and is at risk of bleeding. Clopidigrel is an anti-platelet which would increase the risk of bleeding.
The other interventions would be appropriate for this patient.
The patient may also be placed on bleeding precautions when the platelets are low.
The spleen may be removed to prevent excessive breakdown of platelets. This increases the patient's infection risk. Vaccinations should be up to date and the pt taught how to prevent infection.
A client is receiving a continuous IV heparin drip for a DVT. Two days after beginning the adminstration, the nurse notes the following on the CBC. What is the most appropriate action at this time?
WBC: baseline: 7.2 current: 8.2
RBC: baseline: 4.8 current: 4.6
Hgb: B: 13.1 C: 13.0
Hct: B: 42 C: 43
Platelets: B: 321,000 C: 60,000
a. Increase the rate of heparin
b. Document the findings
c. Stop the heparin
d. Look for S/S of infection
C - stop the heparin
The sudden drop in platelets indicates heparin induced thrombocytopenia is occurring.
Heparin binds with platelet factor 4 which creates highly reactive immune complex that activates platelets.
This leads to the neutralization of the heparin and increases thrombin production. (Produces blood clots!)
S/S: Low circulating platelet count (it's all being used in the clots forming), DVT, PE, etc
The heparin should be discontinuted immediately and a direct thrombin inhibitor started (Ex: Argatroban (Acova).
A client requires administration of WBCs due to neutropenic status. What is the most important part of how a nurse administers this?
a. Admin Through a micro filter
b. With benadryl on board
c. Administer slowly to monitor for reaction
d. With blood tubing
Answer - C - slowly to monitor for reaction
WBC surfaces have lots of antigens, so they are at high risk for reaction. The WBCs should be administered slowly so to notice reaction.
Benadryl and tylenol maybe given prophylactically.
Regular blood tubing can be used for this product.
A client is seen in the HCP office for management of Thrombotic Thrombocytopenic purpura (TTP). Which of the following prescriptions does the nurse expect for this client?
a. aspirin
b. metoprolol
c. 1000mL of normal saline bolus
d. warfarin (coumadin)
TTP is an autoimmune problem when the platelets clump together inappropriately - causing clots in areas of the body. This can cause MI, stroke, kidney failure, etc. (This causes there to be low systemic/circulating numbers - hence the thrombocytopenia)
When trauma occurs, the low circulating numbers can result in hemorrhage.
Often fatal within 3 months if untreated
The goal is to stop the platelet aggregation by using immunosuppressants and an antiplatelet (aspirin)
Plasma removal and infusion of Fresh frozen plasma is helps to remove elements in the pt's blood that causes the clumping.
Warfarin does not work on the platelets, so it is not helpful here.
A client with Hemophilia A is scheuled for surgery. What should the nurse expect to administer just prior to the operation.
a. Platelets
b. Factor IX
c. Fresh Frozen Plasma
d. Factor VIII
Correct - D Factor VIII
Hemophilia A (Classic Hemophilia) is a deficiency of factor VIII (80% of pts) in the clotting cascade
Hemophilia B (Christmas disease) is a deficiency of factor IX (20% of pts) in the clotting cascade
It is a genetic condition
Hemophiliacs have plenty of platelets which function normally as platelet plugs. The clotting factor deficiency, however, prevents formation of stable fibrin clots, so the pt can have excessive bleeding.
Factor IX should be given to the pt with Hem IX prior to surgery to help ensure the pt doesn't hemorrhage
Clotting factors (Ex: VIII or IX) can be made from pooled plasma (not as common any more d/t frequent administration and risk for reaction) or synthetic
Synthetic vasopressin (DDAVP) may increase production of factor VIII for maintenance of mild Hem A
The pt should be watched carefully after the procedure for bleeding.
a. Use a soft bristled toothbrush
b. Avoid contact sports/activities
c. Wear a medical alert bracelet
B - avoid contact sports
All are appropriate interventions, but avoiding contact sports where large injury/bleeding can occur could be life threatening, and therefore avoided.