MDCII EXAM 1 AND 2 BOOTCAMP KAHOOT / RAPID FIRE KAHOOT QUESTIONS

what is tumor lysis syndrome

cancer cells burst open and dump their contents into the blood

what increases with tumor lysis syndrome

• hyperkalemia

• hyperuricemia

• hyperphophatemia

spinal cord compression

severe back pain + new neuro/ bladder symptoms → paralysis risk

SVC syndrome

facial swelling + dyspnea + distended veins

hypercalcemia

bone pain + kidney stones + confusion

third spacing

fluid is there but in the wrong place:

fluid leaks OUT of blood vessels → goes INTO tissues and spaces where it cant be used (ex: tissues and abdomen) → body looks wet on the outside but vessels are dry inside

what are the vessel signs in third spacing (vessel is dry)

• hypotension

• tachycardia

• low urine output

** CRITICAL: NOT ENOUGH FLUID FOR PERFUSION

what are the body signs in third spacing (body looks wet)

• edema

• ascites

• weight gain

** DANGER: FLUID IS STUCK AND CAUSING PROBLEMS

why is third spacing dangerous

fluid exists but cannot circulate → organs dont get perfused → SHOCK

a good memory trick for third spacing

• swollen but dry

• money in a broken ATM → the money is in the ATM but you cant use it

what shoud you watch with chemo patients

if their ANC drops below 500 = infection risk / SEVERE NEUTROPENIA

what is a normal ANC

1500 - 8000

neutropenic precautions

• strict hand hygiene

• no fresh flowers/ plants

• no raw foods (cooked only)

• avoid crowds and sick visitors

signs of a medical emergency in a chemo patient

fever (100.4 degrees fahrenheit) + chemo = medical emergency (SEPSIS)

what is thrombocytopenia

low platelets → cant clot = bleeding risk

normal platelet count

150,000 - 400,000

signs of thrombocytopenia

• bruising

• petechiae

• bleeding gums

actions for thrombocytopenia patient

• soft toothbrush

• electric razor only

• avoid IM injections

skin/ radiation care for a thrombocytopenic patient

• protect skin from sun (sunburn= sun damage)

• no lotions on radiation site unless prescribed

managing mucositis

• avoid anything acidic or spicy

• ice chips + frequent sips

• soft/ bland foods

• no alcohol- based mouthwash

managing peripheral neuropathy

• always wear shoes even indoors

• inspect feet daily

• check bath water temp (CRUCIAL: can’t feel heat)

• study shoes

• numbness = FALL RISK

palliative care

• relieves symptoms (pain/ nausea)

• can still receive curative treatment (chemo/ radiation)

fluid volume deficit (FVD)

• the dry patient

• not enough fluid in the body → think dehydration on steroids

• the body is desperately trying to compensate

what is the treatment and nursing care for FVD

• isotonic fluids (NS or Lactated Ringers)

• daily weights

• strict I&O

what are the cardiovascular signs of FVD

• tachycardia

• hypotension

• weak thready pulse

what are the skin signs of FVD

• poor skin turgor (tenting)

• dry mucous membranes

what labs are elevated in FVD

• BUN/ creatinine

• high urine specific gravity

what is a good memory trick for FVD

dry = everything HIGH

→ High HR, high labs, and high specific gravity

a high specific gravity would show as

concentrated urine (dehydrated/ FVD)

a low specific gravity would show as

diluted urine (overhydrated or DI)

fluid volume excess

• the wet patient

• too much fluid in the body

• every system is overloaded and stressed

THE GOAL: get the fluid OFF

what are the cardiovascular signs of FVE

• bounding pulse

• JVD (jugular vein distention)

• hypertension

what are the respiratory signs of FVE

• crackles in lungs

• dyspnea

what are general signs of FVE

• edema

• rapid weight gain

what is the treatment and nursing care for FVE

• diuretics (furosemide)

• fluid restriction

• low sodium diet

• high fowlers diet

isotonic solution

0.9% NS or Lactated Ringers

** SAME CONCENTRATION AS BLOOD

• it says IN the vessel, does not shift anywhere

what is isotonic IV solution used for

• FVD/ dehydration

• trauma/ blood loss

• surgery patients

• hypovolemic shock

hypotonic solution

0.45% NS

• water moves INTO cells to balance out

• the cells swell up like a hippo (HYPO = HIPPO)

what is a hypotonic solution used for

• cellular dehydration

• hypernatremia (too much sodium so we ned to dilute it)

examples of a patient with cellular dehydration

• hypernatremia patient

• diabetic with very high blood sugar = glucose pulls water out of cells

• patient who dank too much saltwater

hypertonic solution

3% NS

• water moves OUT of cells into vessels

• cells shrink like a raisin (HYPER=WIPER)

what would a hypertonic IV solution be used for

• severe hyponatremia (dangerously low sodium)

• severe cerebral edema

** MUST BE ADMINISTERED SLOWLY AND MONITORED CLOSELY

signs of hyponatremia

• headache

• confusion

• seizures

• coma

• poor skin turgor

• dry mucosa

treatment for hyponatremia

fluid restriction

signs of hypernatremia

• thirst

• dry sticky mucous membranes

• restlessness

• neuromuscular irritability

what is the treatment for hypernatremia

hypotonic fluids

signs of hypokalemia

• muscle weakness

• cramps

• inverted T- waves

treatment for hypokalemia

IV potassium

** NEVER PUSH

nursing care for hypokalemic patients

always monitor ECG during IV administration

causes of hyperkalemia

• renal failure

• tumor lysis syndrome

signs of hyperkalemia

• dysrhythmias

• peaked T waves

treatment for hyperkalemia

• kayexalate

  • insulin/ dextrose (insulin drives potassium FROM the blood INTO the cells → insulin activates the sodium potassium pump and that pump pushes potassium into cells BUT insulin drops blood sugar too so you cant give insulin alone → so you MUST give dextrose alongside with it)

signs of hypocalcemia

trousseau’s sign or chvostek’s sign

• tetany, numbness (circumoral), laryngospasm

signs of magnesium toxicity

• hypotensions

• bradycardia

• absent deep tendon reflexes

antidote for magnesium toxcitiy

calcium gluconate

primary prevention

prevent it

• sunscreen

• no smoking

• vaccines

secondary

screening

• mammogram

• colonoscopy

• pap smear

tertiary prevention

treatment/ rehab

nursing action for SVC syndrome

elevate head of bed

causes of metabolic acidosis

• DKA

• starvation

• sepsis

• renal failure

• severe diarrhea

treatmenr for metabolic acidosis

• treat the underlying cause

• IV fluids

• insulin (for DKA)

• bicarbonate (if severe) → a base that directly neutralizes the acid

causes of metabolic alkalosis

• severe vomiting

• excessive gastric/ NG suction

• long term diuretic use

metabolic alkalosis interventions

• restore fluid volume with sodium chloride (NaCl)

• replace potassium

• administer antiemetics/ reduce suction

what are you monitoring the patient for with metabolic alkalosis

• confusion

• lethargy

• cardiac dysrhythmias

→ because of the hypokalemia

causes of respiratory acidosis

• hypoventilation

• COPD/ asthma attacks

• sedatives/ opioids

• airway obstruction (tumors, anaphylaxis)

treatment for respiratory acidosis

• improve ventilation

• position in high fowler’s

• bronchodilators

• prepare for mechanical ventilation if respiratory rate drops dangerously low (ex: 7/min)

causes of respiratory alkalosis

• hyperventilation

• severe anxiety/ panic attacks

• high altitudes

treatment for respiratory alkalosis

• treat the underlying cause

• antianxiety agents

• have the patient breathe into a paper bag

what should you be watching for in a respiratory alkalosis patient

numbness, tingling of extremities, and muscle spasms

→ because alkalosis inhibits calcium ionization

clues of GERD

• heartburn

• regurgitation

• chest burning after meals

what is the treatment for GERD

• proton pump inhibitors

• H2 blockers

• lifestyle changes

what patient education are you providing to a GERD patient

• keep the head of bed elevated

• strictly avoid caffeine, alcohol, and late meals

clues of diverticular disease

• left lower quadrant pain

• fever

• constipation

treatment for diverticular disease

• antibiotics for infection

• DURING A FLARE: low fiber diet, avoid seeds/ nuts

• MAINTENANCE: high fiber diet

sudden, severe abdominal pain or a rigid, board- like abdomen is a sign of what

perforation

clues of ulcerative colitis

• bloody diarrhea

• severe abdominal pain

• weight loss

priority interventions for an ulcerative colitis patient

• keep patient NPO during exacerbations

• IV hydration & anti- inflammatory medications

• ONGOING DIET: high- calorie, low- fiber

ulcerative colitis patients are at a high risk for what

toxic megacolon

→ closely monitor I&Os, hypokalemia, and CBC levels

what is toxic megacolon

the colon becomes massively dilated and inflamed to the point it can rupture

difference between Crohn’s and UC (the location and presentation)

LOCATION: crohns is anywhere in the GI tract (from mouth to anus) while UC is in the colon only

PRESENTATION: crohns is patchy inflammation (skipped lesions) while UC is a continuous inflammation starting from the rectum

a patient presents with RUQ pain after fatty meals and clay colored stool. what disorder is most likely

cholelithiasis