Med-Surg and Pediatric Clinical Concepts: Oncology, Perfusion, Hematology, and Mobility

Comprehensive practice flashcards featuring high-yield vocabulary terms and definitions across oncologic management, venous thromboembolism, congenital and infectious pediatric cardiac conditions, hematologic dyscrasias, and musculoskeletal disorders.

Apoptosis

The normal physiologic mechanism of programmed cell death, which malignant cancer cells fail to undergo, resulting in unregulated proliferation.

Metastasis

The process by which malignant neoplastic cells invade surrounding tissues and spread through vascular or lymphatic channels to distant anatomical sites.

Primary Cancer Prevention

Interventions aimed at reducing the risk of developing malignant disease in healthy populations through the promotion of healthy lifestyles and the avoidance of known carcinogens.

Secondary Cancer Prevention

Screening and early detection strategies (such as mammography, Pap smears, digital rectal exams, and PSA testing) focused on identifying premalignant states or early-stage malignancies in high-risk individuals.

CAUTION Warning Signs

An acronym representing seven clinical warning signs of cancer: Change in bowel/bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere, Indigestion or difficulty swallowing, Obvious change in a wart or mole, and Nagging cough or hoarseness.

TNM Staging System

A standardized clinical staging framework where $T$ designates the size and local extent of the primary tumor ($\text{T0}\text{--}\text{T4}$), $N$ indicates regional lymph node involvement ($\text{N0}\text{--}\text{N3}$), and $M$ reflects distant metastatic spread ($\text{M0}\text{--}\text{M1}$).

Brachytherapy

Internal radiation therapy that delivers localized radiation via radioactive sealed sources or implants placed directly inside a tumor or within an adjacent anatomical cavity (such as the cervix or uterus).

Neoadjuvant Therapy

Chemotherapy or radiation therapy administered prior to definitive local surgical resection in order to decrease tumor volume and facilitate operative removal.

Non-Coring (Huber-Point) Needle

A specialized angled needle manufactured with a deflected bevel point designed to puncture the silicone septum of an implanted venous access port without slicing or coring the membrane.

Closed-Suction Drains (Hemovac and Jackson-Pratt)

Postoperative closed wound drainage devices utilizing negative pressure; the bulb-shaped Jackson-Pratt reservoir accommodates approximately $100\text{--}200\,\text{mL}$, while the spring-loaded circular Hemovac container accommodates approximately $500\,\text{mL}$.

Methotrexate

An antimetabolite chemotherapeutic agent that arrests cellular replication, requiring vigilant clinical monitoring for stomatitis, severe myelosuppression, nephrotoxicity, and hepatotoxicity.

Cisplatin (Cis-Platinum)

An alkylating antineoplastic agent that disrupts DNA cross-linking, carrying notable risks for bone marrow suppression, nephrotoxicity, hemorrhagic cystitis, gonadal suppression, and secondary malignancies.

Vincristine

An antimitotic chemotherapeutic drug that blocks mitotic spindle formation, characterized by neurotoxic adverse effects including peripheral neuropathy and severe constipation alongside alopecia and stomatitis.

Tamoxifen

A selective estrogen receptor modulator used in breast cancer treatment that produces hot flashes, fluid retention, vaginal dryness, and bone pain, while conferring an elevated risk for venous thromboembolism (VTE).

Imatinib

An oral targeted tyrosine kinase inhibitor serving as standard therapy for chronic myeloid leukemia (CML); common adverse effects include nausea, myalgia, and bleeding, with rare risks of cerebral edema and Stevens-Johnson syndrome.

Post-Mastectomy Lymphedema

Chronic interstitial fluid accumulation causing swelling and cutaneous changes in the ipsilateral arm following axillary lymph node dissection; managed by strict limb elevation, compression garments, and life-long avoidance of blood pressure measurements, venipunctures, or injections in that extremity.

Cheyne-Stokes Respiration

An irregular end-of-life respiratory pattern marked by rhythmic waxing and waning of tidal depth, alternating between periods of hyperpnea and apnea.

Virchow's Triad

The three primary pathophysiologic contributors to the formation of venous thrombosis: hemodynamic changes (venous stasis), vessel wall or endothelial injury, and systemic hypercoagulability.

Deep Vein Thrombosis (DVT)

A thrombus formed within a deep venous vessel (predominantly in the lower extremities) presenting clinically with unilateral edema, localized erythema, pain, and warmth; responsible for more than $90\%$ of pulmonary embolisms.

Heparin-Induced Thrombocytopenia (HIT)

An immune-mediated prothrombotic complication of heparin administration caused by antibodies against platelet factor 4-heparin complexes, resulting in consumptive thrombocytopenia and paradoxically heightened arterial and venous thrombosis risks.

Unfractionated Heparin

A parenteral antithrombotic agent that complexes with antithrombin III to inhibit thrombin and prevent fibrin clot propagation, adjusted via weight-based nomograms to maintain a therapeutic partial thromboplastin time (PTT) of $2\text{--}2.5$ times the laboratory baseline control.

Protamine Sulfate

The specific chemical antidote administered intravenously to rapidly reverse the systemic anticoagulant effects of unfractionated heparin.

Warfarin

An oral anticoagulant that impedes the hepatic synthesis of vitamin K-dependent clotting factors, routinely monitored using prothrombin time (PT target $1.5\text{--}2$ times control) and international normalized ratio (INR target $2.5\text{--}3.5$), and reversed with vitamin K or fresh frozen plasma.

Rivaroxaban

A direct oral anticoagulant that selectively blocks factor Xa, featuring predictable pharmacokinetics that eliminate the requirement for routine PT/INR laboratory monitoring and dietary vitamin K restrictions.

Atrial Septal Defect (ASD)

An abnormal communication between the right and left atria creating an acyanotic left-to-right shunt, increased pulmonary vascular volume, elevated right-sided cardiac pressures, a characteristic systolic murmur, and potential heart failure.

Ventricular Septal Defect (VSD)

A congenital opening in the interventricular septum resulting in left-to-right shunting of oxygenated blood into the higher-resistance pulmonary circuit, accompanied by a loud holosystolic murmur; spontaneous closure occurs in $20\%\text{--}60\%$ of pediatric cases during the first year of life.

Patent Ductus Arteriosus (PDA)

Persistence of the normal fetal conduit between the pulmonary artery and the descending aorta, resulting in increased left-to-right blood flow into pulmonary circulation; successfully closed pharmacologically in preterm neonates using indomethacin.

Tetralogy of Fallot (TOF)

A cyanotic congenital cardiac defect characterized by four anatomic anomalies: a ventricular septal defect (VSD), pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy.

Hypercyanotic Spell ('Tet Spell')

An acute paroxysm of profound arterial hypoxemia, worsening cyanosis, and hyperpnea occurring during feeding, crying, or exertion in patients with Tetralogy of Fallot, relieved clinically by assuming a knee-chest or squatting posture.

Coarctation of the Aorta

A congenital narrowing of the aortic lumen distal to the branch arteries, producing upper-extremity hypertension with bounding pulses alongside lower-extremity hypotension, diminished or absent femoral pulses, and cool lower extremities.

Transposition of the Great Arteries (TGA)

A severe cyanotic cardiac anomaly where the aorta originates directly from the right ventricle and the pulmonary artery from the left ventricle, forming two separate parallel circulations requiring IV prostaglandin $E_1$ postnatally to keep the ductus arteriosus patent.

Digoxin (Pediatric Precautions)

A positive inotropic and negative chronotropic cardiac glycoside that increases myocardial contractility; clinical administration mandates verification by two RNs and withholding the dose if the apical heart rate is $<100\,\text{beats/min}$ in infants or $<70\,\text{beats/min}$ in older children.

Rheumatic Fever

A systemic, non-suppurative post-infectious inflammatory disease provoked by Group A beta-hemolytic streptococcal pharyngitis, manifesting as carditis with valve damage, migratory polyarthritis, erythema marginatum, and Sydenham chorea.

Kawasaki Disease

An acute, self-limiting systemic vasculitis primarily affecting toddlers, diagnosed by high fever ($>102.2^\circ\text{F}$ for $>3\,\text{days}$), strawberry tongue, bilateral conjunctival injection, cervical lymphadenopathy, and peeling extremity erythema; treated with high-dose aspirin and intravenous gamma globulin to avert coronary artery aneurysms.

Bone Marrow Aspiration

A diagnostic procedure collecting hematopoietic tissue, typically from the posterior superior iliac crest; nursing care includes applying direct puncture site pressure for $5\text{--}10\,\text{minutes}$ and keeping the sterile pressure dressing intact for at least $24\,\text{hours}$.

Pernicious Anemia

A megaloblastic anemia caused by autoimmune destruction of gastric parietal cells or absence of intrinsic factor, leading to vitamin $B_{12}$ malabsorption, a beefy red tongue, gastrointestinal disturbances, paresthesias, and a positive Schilling test.

Epoetin Alfa

A recombinant hematopoietic growth factor that stimulates erythropoiesis in bone marrow; prescribed for renal or chemotherapy-induced anemia with a clinical target hemoglobin of approximately $10\,\text{g/dL}$ to avoid hypertensive and thromboembolic events.

Filgrastim

A genetically engineered granulocyte colony-stimulating factor that accelerates neutrophil proliferation to counteract chemotherapy-induced leukopenia; notable side effects include medullary bone pain, splenomegaly, and leukocytosis.

Aplastic Anemia

A severe bone marrow failure syndrome leading to pancytopenia—a simultaneous deficiency of erythrocytes, leukocytes, and platelets—secondary to congenital defects, toxins, chemotherapeutic agents, or idiopathic causes.

Vaso-Occlusive Crisis (VOC)

The most prevalent acute complication of sickle cell disease, caused by rigid sickle erythrocytes obstructing microvascular beds, producing acute tissue ischemia, profound bone or joint pain, and organ infarction.

Splenic Sequestration Crisis

A life-threatening hematologic crisis in sickle cell anemia characterized by the sudden entrapment of massive volumes of sickled blood within the spleen, precipitating rapid splenomegaly, profound anemia, and hypovolemic shock.

Deferoxamine

A parenteral iron-chelating agent administered to bind and eliminate excessive systemic iron stores in patients with transfusion-dependent anemias, such as severe beta-thalassemia (Cooley anemia).

Hemophilia A

An X-linked recessive bleeding disorder resulting from an inherited deficiency of coagulation factor VIII, predisposing patients to prolonged internal or external bleeding rather than an increased rate of bleeding.

Hemarthrosis

Bleeding into a synovial joint space, representing a classic complication of hemophilia that results in joint swelling, deformity, and chronic pain; managed immediately with factor concentrate infusions alongside rest, ice, compression, and elevation (RICE).

Systemic Lupus Erythematosus (SLE)

A chronic multisystem autoimmune inflammatory disorder driven by autoantibodies against cell nuclei (positive ANA test), classically presenting with exacerbations, remissions, multi-organ damage, and a distinctive erythematous facial butterfly (malar) rash.

Hydroxychloroquine

An antimalarial compound used for its disease-modifying immunosuppressive actions in systemic lupus erythematosus and rheumatoid arthritis; requires regular baseline and periodic retinal screenings due to the risk of irreversible ocular toxicity.

Gout

A metabolic arthropathy resulting from hyperuricemia and intra-articular deposition of monosodium urate crystals, triggering acute inflammatory pain (most commonly in the first metatarsophalangeal joint) and managed nutritionally by restricting purine-rich meats, seafood, and alcohol.

Alendronate

A bisphosphonate agent that decreases osteoclast number and action to prevent bone resorption in osteoporosis; must be swallowed with a full glass of plain water upon rising, with the patient remaining upright for at least $30\,\text{minutes}$ to prevent severe esophageal ulceration.

Compartment Syndrome

A limb-threatening condition wherein interstitial fluid pressures rise within an unyielding osteofascial compartment, producing ischemia and the 'six Ps': pain out of proportion to exam, pressure, paresthesia, pallor, paralysis, and pulselessness.

Fasciotomy

A limb-saving surgical emergency intervention in which medial and lateral longitudinal incisions are made through the skin and overlying fascia to decompress high intracompartmental pressures and restore tissue microcirculation in compartment syndrome.

Fat Embolism Syndrome

A serious systemic complication occurring $1\text{--}3\,\text{days}$ following long bone or pelvic fractures, defined by the clinical triad of acute hypoxemia, neurological compromise/confusion, and a petechial rash across the chest and conjunctiva.

Traumatic Rhabdomyolysis

Ischemic skeletal muscle breakdown following severe crush trauma, releasing massive amounts of creatine phosphokinase (CPK) and myoglobin into the blood, leading to tubular obstruction, acute kidney injury, and dark, tea-colored urine.

Developmental Dysplasia of the Hip (DDH)

A pediatric spectrum of acetabular and femoral head malalignments assessed in neonates via Barlow and Ortolani maneuvers, primarily managed in early infancy ($<6\,\text{months}$) using a Pavlik abduction harness.

Talipes Equinovarus (Clubfoot)

A congenital complex musculoskeletal deformity of the foot and ankle characterized by plantar flexion and adduction, successfully treated through the Ponseti method of serial manipulation and weekly plaster casting.

Duchenne Muscular Dystrophy (DMD)

A progressive X-linked recessive neuromuscular disease characterized by dystrophin deficiency, progressive symmetric skeletal muscle wasting, loss of ambulation, and respiratory insufficiency requiring noninvasive ventilation and assisted cough maneuvers.

Postoperative Hip Arthroplasty Precautions

Mechanical restrictions designed to prevent prosthetic dislocation following hip replacement: avoiding hip flexion beyond $90^\circ$, preventing leg crossing or adduction past midline via an abduction pillow, and utilizing raised toilet seats and elevated hip chairs.