U World Hematological Final.
Nuclex Hematology.
Cisplatin
an antineoplastic medication that can cause renal toxicity. Assessment of renal function includes
laboratory values and urine output.
Warfarin (Coumadin)
Anticoagulant given to clients with a mechanical valve replacement
To determine if the client is receiving an appropriate dose, the INR needs to be checked
regularly. A therapeutic INR for a client with a mechanical heart valve is 2.5-3.5. The nurse should not
administer warfarin without checking the INR first. If the INR is >3.5, the nurse should hold the
dose and contact the health care provider for further direction.
Radiation therapy to the head and neck can decrease a client's oral intake due to the development
of mucositis (ie, inflammation of the mouth, esophagus, and oropharynx) and xerostomia (ie, dry
mouth).
These adverse side effects affect speech, taste, and ability to swallow and can have a significant impact on
the client's nutritional status.
The nurse teaches the client to:
• Avoid irritants such as spicy, acidic, dry, or crumbly foods; coffee; and alcohol.
• Consume supplemental nutritional drinks (eg, Ensure), which are often easier to swallow.
• Use artificial saliva to manage xerostomia and the production of thick saliva due to altered
salivary gland function. Sipping water throughout the day is equally effective and less expensive.
• Topical anesthetics (eg, lidocaine) have been found to increase comfort and improve oral intake
• need to maintain more frequent (eg, before and after meals, at bedtime) oral hygiene (eg, using
soft toothbrush, rinsing with baking soda solution) due to the drying effects of mucositis.
Tumor lysis syndrome (TLS)
A potential complication of chemotherapy
A rapid release of intracellular components into the bloodstream. Massive cell lysis releases intracellular
ions (potassium and phosphorus) and nucleic acids into the bloodstream. Catabolism of the nucleic acids
produces uric acid, resulting in severe hyperuricemia. Released phosphorus binds calcium, producing
calcium phosphate mixture but lowering serum calcium levels. Both calcium phosphate and uric acid are
deposited into the kidneys, causing renal injury.
Allopurinol (Zyloprim) blocks the nucleic acid catabolism and prevents hyperuricemia but would not
affect potassium, phosphate, and calcium levels. Chronic gout and uric acid calculi also require the
administration of allopurinol to decrease uric acid accumulation. A normal blood uric acid level for an
adult male is 4.4–7.6 mg/dL and female is 2.3-6.6 mg/dL.
Severe anemia
A normal hemoglobin level for an adult male is 13.2-17.3 g/dL and female is 11.7-15.5 g/dL. Will
have tachycardia, which will maintain cardiac output. Shortness of breath (dyspnea) may occur due to an
insufficient number of red blood cells. The respiratory system must increase the respiratory rate to
maintain adequate levels of oxygen and carbon dioxide. Pallor (pale complexion) occurs from reduced
blood flow to the skin.
, ** Early signs of colorectal cancer are usually nonspecific and include fatigue, weight loss, anemia, and
occult gastrointestinal bleeding. Clients age ≥50 should be screened for colorectal cancer. Early signs
include anemia.
Oral mucositis
inflammation or ulceration of the oral mucosa, results from chemotherapy or radiation therapy. Oral
hygiene practices that minimize oral mucositis and promote comfort include the following:
• Cleansing the mouth with normal saline after meals and at bedtime to promote oral health
• Use of a soft-bristle toothbrush to decrease gum irritation
• Application of prescribed viscous lidocaine HCl (Xylocaine) to alleviate oral pain
• Use of water-soluble lubricating agents to moisten mouth tissues that may become dry due to
therapy
• Avoidance of hot liquids and spicy/acidic foods, which can cause oral discomfort
• avoid antiseptic mouthwashes with alcohol as they are irritating to mucous membranes.
• Administration of palifermin (Kepivance), a recombinant human keratinocyte growth factor,
prevents oral mucositis in clients diagnosed with hematologic malignancies. However, it does
not help with pain. Viscous lidocaine HCl (Xylocaine) alleviates the oral pain caused by
mucositis.
Clopidogrel (Plavix)
platelet aggregation inhibitor used to prevent blood clot formation in clients with recent myocardial
infarction, acute coronary syndrome, cardiac stents, stroke, or peripheral vascular disease.
can cause thrombocytopenia and increase the risk for bleeding, the nurse should notify the health care
provider (HCP) of the low platelet count (normal: 150,000-400,000/mm before administering
Calcium acetate (PhosLo)
control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the
intestines and excreting it in the high (normal adult: 2.4-4.4 mg/dL)
Magnesium sulfate
used to correct hypomagnesemia and treat torsades de pointes and seizures associated with
eclampsia. normal adult: 1.5-2.5 mEq/L
Metformin (Glucophage)
first-line drug for the control of blood sugar in clients with type 2 diabetes mellitus. Glycosylated
hemoglobin (A1C) measures the total hemoglobin that has glucose attached to it, expressed as a
percentage. Glucose remains attached to the red blood cell for the life of the cell (about 120 days) and
reflects glycemic control over an extended period. The recommended A1C level for a client with diabetes
is <7%.
Warning signs of cancer
A mnemonic to remember the warning signs of cancer is CAUTION and includes the following:
Change in bowel or bladder habits
• Black stool may be a sign of colon cancer. Painless hematuria is a symptom of bladder cancer.
A sore that does not heal
• A sore that bleeds and does not heal may be an indication of skin cancer
Unusual bleeding or discharge
• Unusual bleeding or discharge from the vagina may indicate cancer of the cervix or endometrium
Thickening or lump in the breast or elsewhere
Nuclex Hematology.
Cisplatin
an antineoplastic medication that can cause renal toxicity. Assessment of renal function includes
laboratory values and urine output.
Warfarin (Coumadin)
Anticoagulant given to clients with a mechanical valve replacement
To determine if the client is receiving an appropriate dose, the INR needs to be checked
regularly. A therapeutic INR for a client with a mechanical heart valve is 2.5-3.5. The nurse should not
administer warfarin without checking the INR first. If the INR is >3.5, the nurse should hold the
dose and contact the health care provider for further direction.
Radiation therapy to the head and neck can decrease a client's oral intake due to the development
of mucositis (ie, inflammation of the mouth, esophagus, and oropharynx) and xerostomia (ie, dry
mouth).
These adverse side effects affect speech, taste, and ability to swallow and can have a significant impact on
the client's nutritional status.
The nurse teaches the client to:
• Avoid irritants such as spicy, acidic, dry, or crumbly foods; coffee; and alcohol.
• Consume supplemental nutritional drinks (eg, Ensure), which are often easier to swallow.
• Use artificial saliva to manage xerostomia and the production of thick saliva due to altered
salivary gland function. Sipping water throughout the day is equally effective and less expensive.
• Topical anesthetics (eg, lidocaine) have been found to increase comfort and improve oral intake
• need to maintain more frequent (eg, before and after meals, at bedtime) oral hygiene (eg, using
soft toothbrush, rinsing with baking soda solution) due to the drying effects of mucositis.
Tumor lysis syndrome (TLS)
A potential complication of chemotherapy
A rapid release of intracellular components into the bloodstream. Massive cell lysis releases intracellular
ions (potassium and phosphorus) and nucleic acids into the bloodstream. Catabolism of the nucleic acids
produces uric acid, resulting in severe hyperuricemia. Released phosphorus binds calcium, producing
calcium phosphate mixture but lowering serum calcium levels. Both calcium phosphate and uric acid are
deposited into the kidneys, causing renal injury.
Allopurinol (Zyloprim) blocks the nucleic acid catabolism and prevents hyperuricemia but would not
affect potassium, phosphate, and calcium levels. Chronic gout and uric acid calculi also require the
administration of allopurinol to decrease uric acid accumulation. A normal blood uric acid level for an
adult male is 4.4–7.6 mg/dL and female is 2.3-6.6 mg/dL.
Severe anemia
A normal hemoglobin level for an adult male is 13.2-17.3 g/dL and female is 11.7-15.5 g/dL. Will
have tachycardia, which will maintain cardiac output. Shortness of breath (dyspnea) may occur due to an
insufficient number of red blood cells. The respiratory system must increase the respiratory rate to
maintain adequate levels of oxygen and carbon dioxide. Pallor (pale complexion) occurs from reduced
blood flow to the skin.
, ** Early signs of colorectal cancer are usually nonspecific and include fatigue, weight loss, anemia, and
occult gastrointestinal bleeding. Clients age ≥50 should be screened for colorectal cancer. Early signs
include anemia.
Oral mucositis
inflammation or ulceration of the oral mucosa, results from chemotherapy or radiation therapy. Oral
hygiene practices that minimize oral mucositis and promote comfort include the following:
• Cleansing the mouth with normal saline after meals and at bedtime to promote oral health
• Use of a soft-bristle toothbrush to decrease gum irritation
• Application of prescribed viscous lidocaine HCl (Xylocaine) to alleviate oral pain
• Use of water-soluble lubricating agents to moisten mouth tissues that may become dry due to
therapy
• Avoidance of hot liquids and spicy/acidic foods, which can cause oral discomfort
• avoid antiseptic mouthwashes with alcohol as they are irritating to mucous membranes.
• Administration of palifermin (Kepivance), a recombinant human keratinocyte growth factor,
prevents oral mucositis in clients diagnosed with hematologic malignancies. However, it does
not help with pain. Viscous lidocaine HCl (Xylocaine) alleviates the oral pain caused by
mucositis.
Clopidogrel (Plavix)
platelet aggregation inhibitor used to prevent blood clot formation in clients with recent myocardial
infarction, acute coronary syndrome, cardiac stents, stroke, or peripheral vascular disease.
can cause thrombocytopenia and increase the risk for bleeding, the nurse should notify the health care
provider (HCP) of the low platelet count (normal: 150,000-400,000/mm before administering
Calcium acetate (PhosLo)
control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the
intestines and excreting it in the high (normal adult: 2.4-4.4 mg/dL)
Magnesium sulfate
used to correct hypomagnesemia and treat torsades de pointes and seizures associated with
eclampsia. normal adult: 1.5-2.5 mEq/L
Metformin (Glucophage)
first-line drug for the control of blood sugar in clients with type 2 diabetes mellitus. Glycosylated
hemoglobin (A1C) measures the total hemoglobin that has glucose attached to it, expressed as a
percentage. Glucose remains attached to the red blood cell for the life of the cell (about 120 days) and
reflects glycemic control over an extended period. The recommended A1C level for a client with diabetes
is <7%.
Warning signs of cancer
A mnemonic to remember the warning signs of cancer is CAUTION and includes the following:
Change in bowel or bladder habits
• Black stool may be a sign of colon cancer. Painless hematuria is a symptom of bladder cancer.
A sore that does not heal
• A sore that bleeds and does not heal may be an indication of skin cancer
Unusual bleeding or discharge
• Unusual bleeding or discharge from the vagina may indicate cancer of the cervix or endometrium
Thickening or lump in the breast or elsewhere
