408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).

General knowledge

 Protocols for hanging blood/blood transfusions

o Stay in the room for 15 min
o Blood cross typing
o Stop transfusion if there is a rx
o 99% of the times, bag of blood and bag of saline in a Y and in a rx you stop the blood and
open the NS (know the protocol of your facility)
o Pt must sign consent before transfusion – if pt isn’t able to consent proxy can do so – in
an emergency the doctor can consent
 Decisions about cancer treatment are based on type of cancer, staging, metastatic, client’s
health status
o Based on type of cancer, stage, and pt health status
 Dosage calculation
 Post-surgery medications
o Pain medication (which ones and side effects)
 Types of cytopenia associated with hematologic and oncologic disorders
o Anemia, thrombocytopenia (cytopenia-reduce blood cells), know value numbers
 Types of cytopenia associated with treatments for oncologic disorders

Oncological Disorders

 Biopsy types
o Needle aspiration (fine needle to aspirate the cell), incisional (very large tumor- only
take a small piece), excisional (excising all the tumor), spinal cord
 Chemotherapy and side effects
o Nausea and vomiting, alopecia, weight loss, stomatitis (inflammation of oral mucosa-
change way they eat bc its very painful- and give antibiotics and oral anesthetic- magic
mouthwash w/ lidocaine)
 Stomatitis
 S/S of skin cancer
o Basocell: small and waxy (sun exposure areas)
o Squamous: ulcer, rough, scaly, (ask them hx- what was the exposure)
o Melanoma
o Risks: UV exposure (tanning beds)
 non-hodgkins lymphoma – S/S, risk factors
o autoimmune disorder, very aggressive
o risks: HIV pt, prior cancer, exposure to agent orange and other toxins
o s/s: fever, night sweat, fatigue, swollen lymph node
 408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).
Chapter 23 Chest and Lower Respiratory Tract Disorders
Lung cancer

 Signs and symptoms, treatment

 Risk factors: smoking, pollutants, environmental, genetics
 S/s: late in the disease, fatigue, weight loss, persistent cough, hoarseness, chest pain, plural
friction rub, cough with blood
 Tx: lobectomy, chemo and radiation before surgery, combination tx, teach and education
 Small cell lung cancer (SCLC) – signs and symptoms, treatment

Chapter 32 Assessment and Treatment Hematologic Disorders

 Blood Transfusions

Chapter 33 Nonmalignant Hematologic Disorders

Sickle Cell

 Physiology:
 Symptoms: very painful (cells are misshapen and get caught usually in capillary beds in joints),
jaundice bc of increased bilirubin, more susceptible to infection, anemia, fever
 Complications: table 33-2: stroke, bacteremia, infections
 Bacteremia: bacteria in the bloodstream – can go into respiratory distresses
 Pain treatment: meds at all times, pain medication
 Fluids and blood transfusions

Anemia

 S/s: fatigue, pale skin, SOB, cold extremities, decreased (table 33-1?)
 Diagnosis and follow-up care: Doctor will order CBC, iron study, occult blood studies, bone
marrow aspiration (if it is very low)
 Nursing care and interventions: education about energy conservation, iron between meals with
orange juice, folic acid and b-12, monitor for heart failure, expect black/tarry stools, high in
protein diet
 Iron Supplementation: iron pills, IV, liquid, or blood transfusions
 Pernicious anemia – diagnostic criteria and treatment
 Folic acid deficiency anemia & dietary considerations
o Organ meats, leafy greens, garbanzo beans, pinto beans
o Folic acid supplements
 Assessing the client’s activity tolerance
o Have adequate rest periods to conserve energy

Chapter 34 Hematologic Neoplasms

Leukemia

 Leukemia: unregulated proliferation of blood cells,

 Types of leukemia - Commonality and differences
 408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).
 AML: defect in the hemopoietic stem cell
o splenomegaly, pallor, ecchymosis, hyperplasia of bone
o tx: induction therapy (chemo), supportive care, stem cell transfusion, wait for them to
recover and then they will go into conservation therapy
 CML: very aggressive, leads to metastasis, bleeding, headaches, prognosis less than 2 years
 ALL:
 CLL: malignant clone of b-lymphocytes
o Night sweats, fever
o Increased lymphocytes
o Wait and see chemo tx
 CLL- early signs and symptoms and diagnosis
 Induction therapy
 Effects of bone marrow suppression
o Increased risk for infection – teach to be hygienic, avoid sick people
o Might have to be in antibiotics if they have fever

Chapter 38 Rheumatic Disorders

 Osteoarthritis (OA)
o s/s: joint pain, stiffness,
o degenerative joint disease, affects activities
o tx: lose weight, excessive, strength training, joint replacement
o medication (Tylenol, cox-2, NSAIDS)
 Rheumatoid arthritis (RA)
o Autoimmune
o s/s: morning stiffness when they wake up, affects joints bilaterally, fever, anorexia
o diagnostics: labs, s-rays
o medication: methotrexate, NSAIDS,

Chapters 39 & 40 Musculoskeletal Function and Care

Osteomyelitis

 Bone infection
 Chronic and acute
 Diabetic osteomyelitis
o External wounds, vascular insufficiency
 Clinical manifestations
 Treatments: bone graft, antibitions
 Paint management: improve bmobility

Osteoporosis

 Risk factors for developing the disease

o Post menopals, immobility, GI malabsolption, alcoholism
 Medications: calicim, vitamin D,
 408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).
 Signs and symptoms: pain, compression, pt can get shorter
 Diagnostic testing: done density
 Hypocalcemia and parathyroid connection: Ca+ lower than normal (values 9-11)

CHAPTER 40, 42 Musculoskeletal Care and Trauma

Amputation

 Plain or traumatic
 Hypovolemic shock (know signs)
 Phantom pain: pt pain is real,
 Pain medication: pain and nausea management
 Post-op nursing actions and interventions
o Early ambulation
o Wound care
o Look at vitals
o Emotional aspect

Fractures

 Nursing care plan:

 Neurovascular evaluation and monitoring: compare pulses in BOTH extremities
 Hip fractures:
o signs and symptoms: one leg is shorter than the other, pain in hip or groin
o risks
 Fat embolism
o After orthopedict trauma
 External fixation device – post-op nursing management
o Bandage
o Neuro check every 4 hours
o Assess skin
o Pain management
o Reassurance
 Mandible fracture – post-op risks

Arthroplasty

 Replacement of serverly damaged joint

 Indications for arthroplasty
 total hip arthroplasty (replacement): Ambulation and other interventions post-op
o infection, dislocation, assess if ice pack needed
o abduction: away from body
o adduction: bring towards body

Traumatic Injury
 408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).
 Assessment and priority nursing action

Complications from casts, splints, braces ( know which is which)

 Compartment syndrome: pressure withing confined space, blood flow is compromised,

emergency fasciectomy

CHAPTER 47 Intestinal and Rectal Disorders

Colorectal cancer

 Early detection: tenesmus (urge to go)

 Screening: CBC
 Colonoscopy: age parameters, how often should they do the test, bowel prep

CHAPTER 58 Breast Disorders

Breast cancer

 Treatments: lumpectomy, radiation, chemo, mastectomy (radical or – know types)

 Medications and adverse effects
o Combination of txs (adjuct)
 Neutropenia (low levels of neutrophils) risk for infection
 Instructions for immunocompromised patient

CHAPTER 59 Male Reproductive Disorders

Testicular cancer

 Early signs and symptoms: men will delay tx bc of shame

 Tests: tumor marker AFP, Beta-FCG
 S/s; pain, lump
 Client teaching: young men sperm bank prior to tx, pt teaching chemo side effect

CHAPTER 41 Back pain

 Therapeutic interventions: nonpharmlaotgical, ice/hot pack, muscle relaxant (drowsiness),

NSAIDS)
 Treatments
 Client teaching

Drug List

 Tamoxifen: reduce chance of breast cancer in women who are likely to have cancer, monitor for
excess bleeding (menstrual), vaginal dryness, DVT, take for the rest of their life
 408 Exam 2 Study Guide: Musculoskeletal/Hematology and Oncology

There are 50 questions on this test – 2 med calcs. The information in the study guide is meant to
guide your studying. Test content can include, but is not limited to the information in the study
guide. Make sure to complete the readings for each module – keep in mind that content from this
course (Adult Health II) can build on content learned in 407 (Pharm II).
 Chemotherapy – action, side effects, nursing interventions for clients taking chemo: chemo for x
amount of weeks, rest, then do it again. Might switch drugs if not effective
 Oral iron supplements (take with vitamin C)
 Normal saline
 Hydromorphone

Lab Values

 Range for hemoglobin and hematocrit (p. 694)