NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
“Hematology and Oncology are basically
cousins” Talking about the basic subjects
for A/P
Whatever the cancer is, make sure we remember that it is also a heme and
immunological problem. They’re all related.
- A lot of people in the cancer floor will have alopecia due to the toxicity of the
chemo
- Paleness due to anemia (loss of blood due to chemo)
- Black people: do we see paleness? No, so look at the mucous
membranes.
- Fissures in lips; thrush on tongue from fungal infection
- Ecchymosis (bruises)
- RBC, WBC, platelets → the lack of clotting is the
problem due to thrombocytopenia
- Clubbing of fingers due to chronic hypoxia
- Nail beds are also important re: looking for color
- Cap refill: <2 seconds (3 is too much)
- Lymph nodes (flat-palmed brush down the side of neck and up the
axillary area as demonstrated by Gwak)
- “Police station” that monitors invaders
Each RBC carries 3x108 hemoglobin molecules; so not enough RBC = not enough
hemoglobin
= insufficient oxygen = short of breath
- Most heme patients, most cancer patients are anemic and are short of breath
- This directly links to cardiac problems which will link to lung congestion
→ CHF on both sides
- Left HF which leads to right HF (not frequently the other way
around)
- Right HF = remember LIVER
Compensatory mechanisms:
- Heart has to pump faster and harder to make up for the lack of oxygenation
- Leads to HF
- Oncology patients will have EKGs and CXR (cancer patients ARE
cardiac patients)
- Lungs have to work harder and faster to compensate as well
- The oxygenation hemoglobin dissociation curve
- Shift to the left = pH is alkaline and Hb will not release oxygen
- Shift to the right = pH is acidic and Hb will release oxygen
- Do not depend on O2 saturation alone
,NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
- O2 of 90% does not alone mean that you need to give oxygen
- O2 of 99% + shortness of breath could mean something is
wrong
- ABGs are the most important
,NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
- GI system:
- If you don’t have enough blood to supply the GI system, it’s going to
slow down the peristaltic movement
- Food doesn’t go anywhere
- Bowel sounds are diminished = feel uncomfortable
- Nutrition doesn’t happen
- In cancer patients, check bowel sounds
- Don’t call doctor unless you assess
- Cancer patients will frequently be on proton pump inhibitors
and antacid to control development of stomach ulcers
- High phosphate levels in renal patients need to be flushed out
by aluminum
- It’s not about the stomach; it’s about the bones (high
phosphate = low calcium in blood; bones will lose
calcium)
- The liver will enlarge and hepatomegaly results
- The liver does so many important functions, like making
globulins, albumin, storing glucose, making clotting
factors (lack of which leading to bruises, bleeding in
stool, hematuria)
- Check liver enzymes (ALP, AST, ALT)
- Chemo knocks out bone marrow
- Renal system:
- If kidneys don’t filter out well (due to lack of perfusion from
anemia), edema results
- GFR depends on left ventricular output
- Insufficient stroke volume = blood will
insufficiently perfuse kidneys and then kidneys will
start to shut down
- Edema results from insufficient kidney elimination of fluids
(urine)
- Can’t make urine; urine output drops
- Bones:
- Bone marrow make the RBCs, WBCs, platelets
- Aplastic anemia = patient will die
- Bone marrow transplants if it reaches this stage
- MD will constantly want blood work to monitor for aplastic
crisis
- Neuro:
- If CNS doesn’t get perfused, messages can’t be sent sufficiently
- Paresthesia (tingles, burns, nerve pain)
- Not A/O; lethargic, disoriented, pupils not responsive
- Every single one of the 12 cranial nerves could be
affected (think especially of CN X)
, NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
Cancer patients #1 complaint, no matter what kind of cancer: malaise →
don’t want to eat, general flu like symptoms, never quite ready to get
going in morning, weight loss
2022
“Hematology and Oncology are basically
cousins” Talking about the basic subjects
for A/P
Whatever the cancer is, make sure we remember that it is also a heme and
immunological problem. They’re all related.
- A lot of people in the cancer floor will have alopecia due to the toxicity of the
chemo
- Paleness due to anemia (loss of blood due to chemo)
- Black people: do we see paleness? No, so look at the mucous
membranes.
- Fissures in lips; thrush on tongue from fungal infection
- Ecchymosis (bruises)
- RBC, WBC, platelets → the lack of clotting is the
problem due to thrombocytopenia
- Clubbing of fingers due to chronic hypoxia
- Nail beds are also important re: looking for color
- Cap refill: <2 seconds (3 is too much)
- Lymph nodes (flat-palmed brush down the side of neck and up the
axillary area as demonstrated by Gwak)
- “Police station” that monitors invaders
Each RBC carries 3x108 hemoglobin molecules; so not enough RBC = not enough
hemoglobin
= insufficient oxygen = short of breath
- Most heme patients, most cancer patients are anemic and are short of breath
- This directly links to cardiac problems which will link to lung congestion
→ CHF on both sides
- Left HF which leads to right HF (not frequently the other way
around)
- Right HF = remember LIVER
Compensatory mechanisms:
- Heart has to pump faster and harder to make up for the lack of oxygenation
- Leads to HF
- Oncology patients will have EKGs and CXR (cancer patients ARE
cardiac patients)
- Lungs have to work harder and faster to compensate as well
- The oxygenation hemoglobin dissociation curve
- Shift to the left = pH is alkaline and Hb will not release oxygen
- Shift to the right = pH is acidic and Hb will release oxygen
- Do not depend on O2 saturation alone
,NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
- O2 of 90% does not alone mean that you need to give oxygen
- O2 of 99% + shortness of breath could mean something is
wrong
- ABGs are the most important
,NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
- GI system:
- If you don’t have enough blood to supply the GI system, it’s going to
slow down the peristaltic movement
- Food doesn’t go anywhere
- Bowel sounds are diminished = feel uncomfortable
- Nutrition doesn’t happen
- In cancer patients, check bowel sounds
- Don’t call doctor unless you assess
- Cancer patients will frequently be on proton pump inhibitors
and antacid to control development of stomach ulcers
- High phosphate levels in renal patients need to be flushed out
by aluminum
- It’s not about the stomach; it’s about the bones (high
phosphate = low calcium in blood; bones will lose
calcium)
- The liver will enlarge and hepatomegaly results
- The liver does so many important functions, like making
globulins, albumin, storing glucose, making clotting
factors (lack of which leading to bruises, bleeding in
stool, hematuria)
- Check liver enzymes (ALP, AST, ALT)
- Chemo knocks out bone marrow
- Renal system:
- If kidneys don’t filter out well (due to lack of perfusion from
anemia), edema results
- GFR depends on left ventricular output
- Insufficient stroke volume = blood will
insufficiently perfuse kidneys and then kidneys will
start to shut down
- Edema results from insufficient kidney elimination of fluids
(urine)
- Can’t make urine; urine output drops
- Bones:
- Bone marrow make the RBCs, WBCs, platelets
- Aplastic anemia = patient will die
- Bone marrow transplants if it reaches this stage
- MD will constantly want blood work to monitor for aplastic
crisis
- Neuro:
- If CNS doesn’t get perfused, messages can’t be sent sufficiently
- Paresthesia (tingles, burns, nerve pain)
- Not A/O; lethargic, disoriented, pupils not responsive
- Every single one of the 12 cranial nerves could be
affected (think especially of CN X)
, NURS EXAM 411 REVIEW SESSIONS STUDY GUIDE
2022
Cancer patients #1 complaint, no matter what kind of cancer: malaise →
don’t want to eat, general flu like symptoms, never quite ready to get
going in morning, weight loss
