Oncological Disorders NCLEX Review

Oncological Disorders

Cancer a malignant neoplastic disorder that can involve all body organs with manifestations that vary according to the body system affected and type of tumor cells.
Effects:

Impaired immune and hematopoietic (blood producing) function
Altered gastrointestinal tract structure and function
Motor and sensory deficits
Decreased respiratory function

Cancer classification

Solid tumors: Associated with the organs from which they develop, such as breast cancer or
lung cancer
Hematological cancers: Originate from blood cell–forming tissues, such as leukemias, lymphomas, and multiple myeloma.

Factors that influence cancer development

Environmental contributor

Chemical carcinogen: Industrial chemicals, medications, and tobacco. Physical carcinogen: Ionizing radiation and ultraviolet radiation
Viral carcinogen: Epstein-Barr virus, hepatitis B virus, and human papillomavirus (HPV).
Helicobacter pylori infection increased risk of gastric cancer.
Obesity and dietary factors
Genetic predisposition
Advancing age
Immunosuppressed individuals (e.g. HIV-AIDS, and organ transplant recipients)

Warning signs: " C A U T I O N U S"

▪ Change in bowel or bladder habits
▪ Any sore that does not heal
▪ Unusual bleeding or discharge
▪ Thickening or lump in breast or elsewhere
▪ Indigestion
▪ Obvious change in wart or mole
▪ Nagging cough or hoarseness

▪ Unusual anemia
▪ Sudden weight loss

Diagnostic Tests

Biopsy is the definitive means of diagnosing cancer and provides histological proof of malignancy.

Common types:

Needle: Aspiration of cells
b. Incisional: Removal of a wedge of suspected tissue from a larger mass
c. Excisional: Complete removal of the entire lesion

Frozen Section (Cryosection)	Permanent Paraffin Section
> Time: Fast result (minutes)	> *Time:*Takes about 24hrs for the result
> Quality: Lower quality result	> *Quality:* Clearer details can be obtained

Nursing Interventions:

a. Prepare the client for the diagnostic procedure
b. Obtain informed consent.
c. Provide post procedure instructions (*Pain management).

Causes of pain:

Bone destruction
Obstruction of an organ
Compression of peripheral nerves
Infiltration
Inflammation, necrosis
Psychological factors, such as fear or anxiety

"Assess the client’s pain. Do not under medicate the client with cancer who is in pain."

*Pain Management:

Severity of Pain	Pharmacologic Tx	Nonpharmacologic Tx
Mild to Moderate	Salicylates, Acetaminophen Paracetamol Nonsteroidal Antiinflammatory Drugs (NSAIDs)	Relaxation (e.g.Deep breathing exercises, meditation, yoga) Guided imagery Biofeedback Massage Heat-cold application
Severe	Codeine sulfate Morphine sulfate Methadone Hydromorphone hydrochloride	Monitor V/S Collaborate with other healthcare team members and HCP

2. Bone marrow examination (particularly if a hematolymphoid malignancy is suspected)
3. Chest radiograph
4. Complete blood count (CBC)
5. Computed tomography (CT)
6. Cytological studies (Papanicolaou test)
7. Liver function studies
8. Magnetic resonance imaging (MRI)
9. Proctoscopic examination (including guaiac test for occult blood)
10. Radiographic studies (mammography)

Treatments

Sugery indicated to diagnose, stage,and treat certain types of cancer. Decreases the number of cancer cells; therefore, it may increase the chance that other therapies will be successful.

Types:

Prophylactic surgery: performed in clients with an existing premalignant condition that strongly predisposes to the development of cancer.
Curative surgery: All gross and microscopic tumor is removed or destroyed.
Control (cytoreductive or “debulking”) surgery:consists of removing a large portion of a locally invasive tumor.
Palliative surgery: performed to improve quality of life during the survival time.
Reconstructive or rehabilitative surgery: Performed to improve quality of life by restoring maximal function and appearance, such as breast reconstruction after mastectomy.

Adverse effects of surgery

1. Loss or loss of function of a specific body part
2. Reduced function as a result of organ loss
3. Grieving about altered body image
4. Pain, infection, bleeding, thromboembolism

Chemotherapy kills or inhibits the reproduction of neoplastic cells and kills normal cells.

Common side effects:

Immunosuppression
Mucositis
Fatigue
Alopecia
Nausea and vomiting

*General Nursing Interventions:

Physiological Integrity	Safe and Effective Care Environment	Psychosocial Integrity	Health promotion and maintenance
Monitor CBC, BUA, electrolytes	Prepare IV chemotherapy in an air-vented space	Instruct the client about the possibility of temporary hair loss	Diarrhea: avoid spicy foods, high-fiber foods, and foods that are hot in temperature
Initiate bleeding precautions if thrombocytopenia (PC <50,000 mm3) occurs.	Wear personal protective equipment; gloves, gown, mask, eye shield	Discuss the purchase of a wig before treatment starts	Carry out good oral hygiene
Avoid intramuscular injections and venipunctures as much as possible	Monitor for phlebitis with IV administration	Discuss the potential effect of infertility, which may be irreversible.	Avoid over crowded places and sick people
Monitor for fever, sore throat, and signs and symptoms of infection	Monitor for skin breakdown	Instruct the client about the need for contraception	Bleeding precautionary measures
Monitor for nausea and vomiting DIET: high-caloric, high protein	Reduce IV site pain by altering IV rates or warming the injection site		Consult the HCP before receiving vaccinations (live vaccines)
Administer antiemetics several hours before chemotherapy and for 12 to 48 hours after as prescribed	Notify the HCP if symptoms persist
Increase OFI; at least 2L/day

Treatments:

Types	Positive	Negative	Nursing Care
Radiation Therapy	Destroys cancer cells, with minimal exposure of normal cells to the damaging effects of radiation. Effective on tissues directly within the path of the radiation beam.	Local skin changes and irritation Alopecia (hair loss) Fatigue (most common side effect of radiation) Altered taste sensation;	General care: Wash the irradiated area gently each day with mild soap and water. Use the hand rather than a washcloth to wash the area. Do not remove the markings that indicate exactly where the beam of radiation is to be focused. Dry the irradiated area with patting motions; use a clean, soft towel or cloth. NO powders, ointments, lotions, or creams on the radiation site unless they are prescribed by the HCP. Wear soft clothing Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. Avoid heat exposure to the sun.
Brachytherapy	The radiation source comes into direct, continuous contact with tumor tissues for a specific time.	For a period of time, the client emits radiation and can pose a hazard to others	The same care
*Subtype:* Unsealed Brachytherapy	------	Not confined completely to one body area, and it enters body fluids and eventually is eliminated via various excreta, which are radioactive and harmful to others.	The same care
Sealed Brachytherapy	Temporary or permanent radiation source (solid implant) is implanted within the tumor target tissues.	The client emits radiation while the implant is in place, but the excreta are not radioactive.	Place the client in a private room with a private bath. Place a radiation precaution sign on the client’s door. Organize nursing tasks to minimize exposure to the radiation source. Nursing assignments should be rotated. Limit time to 30 minutes per care provider per shift. Wear a dosimeter film badge to measure radiation exposure. Lead shielding may be used. Limit visitors to 30 minutes per day; visitors should be at least 6 feet away from the source. Save bed linens and dressings until the source is removed;
*------*	------	------	*Prioritization!* Sealed Radiation Implant that Dislodges: 1. Encourage the client to lie still. 2. Use a long-handled forceps to retrieve the radioactive source. 3. Deposit the radioactive source in a lead container. 4. Contact the radiation oncologist. 5. Document the occurrence and the actions taken.
External beam radiation (teletherapy)	The actual radiation source is external to the client. The client does not emit radiation and does not pose a hazard to anyone else.	Burn injuries Skin breakdown Erythema on site	The same care

Bone marrow transplantation (BMT) and Peripheral blood stem cell transplantation (PBSCT) procedures that replace stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy.

Types of donor stem cells

1. Allogeneic: Stem cell donor is usually a sibling, a
parent with a similar tissue type, or a person who
is not related to the client (unrelated donor).
2. Syngeneic: Stem cells are from an identical twin.
3. Autologous most common type.
a. The client receives his or her own stem cells.
b. Stem cells are harvested during disease remission and are stored frozen to be reinfused later.

Procedure

1. Harvest

- Apheresis or leukapheresis (the blood is removed through a central venous catheter and an apheresis machine removes the stem cells and returns the remainder of the blood to the donor). Length of time: 4-6hrs
- Harvested through multiple aspirations from the iliac crest.
- Filtered for residual cancer cells.
- Allogeneic marrow is transfused immediately; autologous marrow is frozen for later
  use (cryopreservation).

2. Transplantation

- Administered through the client’s central line (IV infusion or by IV push) in a manner similar to that for a blood transfusion.

4. Engraftment

- Occurs when the white blood cell (WBC), erythrocyte, and platelet counts begin to rise.
- Engraftment process takes 2 to 5 weeks.

Complications

Infection
Bleeding
Neutropenia (Decrease neutrophil count)
Thrombocytopenia (Decrease platelet count)
Graft-versus-host disease
Hepatic veno-occlusive disease occlusion of the hepatic venules by thrombosis or phlebitis. S/sx: Right upper quadrant abdominal pain, jaundice, ascites, weight gain, and hepatomegaly.

Leukemia

A group of hematological malignancies involving abnormal overproduction of leukocytes, usually at an immature stage, in the bone marrow.

Major types:

Lymphocytic (involving abnormal cells from the lymphoid pathway)
Myelocytic or myelogenous (involving abnormal cells from the myeloid pathways).

Classification of Leukemia

1. Acute Lymphocytic Leukemia
▪ Mostly lymphoblast present in bone marrow
▪ Age of onset is younger than 15 years.

2. Acute Myelogenous Leukemia
▪ Mostly myeloblast present in bone marrow
▪ Age of onset is between 15 and 39 years.

3. Chronic Myelogenous Leukemia
▪ Mostly granulocytes present in bone marrow
▪ Age of onset is in the fourth decade

4. Chronic Lymphocytic Leukemia
▪ Mostly lymphocytes present in bone marrow
▪ Age of onset is after 50 years

Signs and Symptoms:

Headache
Bone pain and joint swelling
WBC count (normal, elevated, or reduced)
Decreased hemoglobin and hematocrit levels, platelet count
Anorexia, fatigue
Anemia
Overt bleeding
Positive bone marrow biopsy identifying leukemic blast–phase cells

Interventions:

Initiate protective isolation procedures.
Ensure frequent and thorough hand washing by the client, family, and HCPs.
Visitors with known infection should avoid contact with the client.
Use strict aseptic technique for all procedures.
Place the client in a room with high-efficiency particulate air filtration or a laminar airflow system if possible.
Initiate a bowel program to prevent constipation and prevent rectal trauma.
Auscultate lung sounds, and encourage the client to cough and deep-breathe.
Instruct the client to avoid activities that expose the client to infection, such as changing a pet’s litter box or working with house plants or in the garden.
Reduce exposure to environmental organisms by eliminating fresh or raw fruits and vegetables
(low-bacteria diet) from the diet; and avoid leaving standing water in the client’s room.
Monitor for signs of bleeding tendencies.
Emphasize safety measures and precaution.
Emphasize the importance of a healthy lifestyle modification.

Lymphoma: Hodgkin’s Disease is a malignancy of the lymph nodes that originates in a single lymph node or a chain of nodes.

Involvement:

Lymph nodes
Tonsils
Spleen
Bone marrow

Risk Factors:

Viral infection
Combined chemotherapy

Signs and Symptoms:

Fever
Sudden anemia
Presence of Reed-Sternberg cells in nodes
Night sweats
Body malaise

Nursing considerations:

Extensive external radiation of the involved lymph node regions (earlier stage; 1 and 2)
Radiation and multiagent chemotherapy (advance stage)
*Refer to general oncological nursing care

Multiple Myeloma invasion of proliferated malignant plasma cell inside the bone marrow that destroys the bone.

Signs and Symptoms:

Bone (skeletal) pain
Weakness and fatigue
Recurrent infections
Anemia
Urinalysis shows Bence Jones proteinuria and elevated serum protein level
*Osteoporosis
Thrombocytopenia and leukopenia
Elevated calcium and uric acid levels

Nursing considerations:

Provide supportive care to control symptoms and prevent complications
Maintain neutropenic and bleeding precautions
Increase OFI; 2L/day
Encourage mobility
Take medications as prescribed (bisphosphonate, antibiotics, analgesics, antineoplastic agents)
Prepare the client for local radiation therapy

Different types of Neoplastic Disease

Type of Cancer	Definition	Age variation	Signs and Symptoms	Treatment	Nursing care
Testicular Cancer	Arises from germinal epithelium, sperm-producing germ cells or from nongerminal epithelium	15 - 40 years old	*Early:* Painless testicular swelling “Dragging” or “pulling” sensation Palpable lymphadenopathy Late: back or bone pain and respiratory symptoms.	Orchiectomy	Pre-op Care: Administer chemotherapy as prescribed. Prepare the client for radiation therapy as prescribed. Prepare the client for surgery Discuss reproduction, sexuality, and fertility information. Post-op Care: Monitor VS, I & O, bleeding, signs of infection Monitor intake and output. Notify the HCP if chills, fever, increasing pain or tenderness at the incision site, or drainage from the incision occurs Instruct the client to avoid heavy lifting and strenuous activity. Perform a monthly testicular self-examination on the remaining testicle (the same day each month). *Gynecomastia may indicate metastasis.
Cervical Cancer	Due to the abnormal growth of cells that have the ability to invade the cervix and other pelvic structures.	25 - 29 years old	Painless vaginal postmenstrual and postcoital bleeding Foul-smelling or serosanguineous vaginal discharge Pelvic, lower back, leg, or groin pain Anorexia and weight loss Leakage of urine and feces from the vagina Dysuria Hematuria	Nonsurgical: ▪ Chemotherapy ▪ Cryosurgery ▪ External radiation ▪ Internal radiation implants (intracavitary) ▪ Laser therapy Surgical: ▪ Conization ▪ Hysterectomy ▪ Pelvic exenteration	Pre-op Care: Provide information regarding the prcedure Obtain informed consent Identify anxiety level Post-op Care: Monitor VS, I&O, bleeding, bowel sounds Assist with coughing and deep-breathing exercises and early ambulation Apply antiembolism stockings or sequential compression devices as prescribed. Avoid strenuous activity or lifting anything weighing > 20 pounds (9 kg). * >1 saturated pad/hr = hemorrhage
Ovarian Cancer	Grows rapidly, spreads fast, and is oftenbilateral. It has a higher mortality rate than any other cancer of the female reproductive system.	55 - 65 years old	Gastrointestinal disturbances Dysfunctional vaginal bleeding Abdominal mass Elevated tumor marker (i.e., CA-125) External radiation therapy Chemotherapy Surgery: TAHBSO		Similar care as to cervical cancer
*Endometrial (Uterine) Cancer*	A slow-growing tumor arising from the endometrial mucosa of the uterus	> 60 years old	Abnormal vaginal bleeding/discharge Late: Low back, pelvic, or abdominal pain Advance: Enlarged uterus	Nonsurgical: External or internal radiation Chemotherapy Progesterone therapy Tamoxifen Surgical: TAHBSO	Similar care as to cervical cancer
Breast Cancer	Invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern.	> 40 years old	Nipple retraction Skin dimpling,retraction, or ulceration Peau d’orange skin A fixed, irregular, painless mass Irregular in shape	Nonsurgical: Chemotherapy Radiation therapy Surgical: Mastectomy (simple, modified radical) Lumpectomy	*BSE:* Perform regularly 7 to 10 days after menses. Postmenopausal clients or hysterectomy clients should perform BSE regularly Post-op Care: Monitor vital signs. Position the client in a semi-Fowler’s position; Unaffected: turn from the back; NO weight lifting Affected: elevate arm above the level of the heart Encourage coughing and deep breathing. Assist in doing fist pump exercise following surgery. Assess operative site regularly. Provide the use of a pressure sleeve as prescribed if edema is severe. Diet: Low salt (edema) *PROTECT THE AFFECTED ARM
Esophageal Cancer	A malignancy found in the esophageal mucosa	40 - 74 years old	Dysphagia Odynophagia Epigastric pain Link	Chemotherapy Radiation therapy Surgical resection of the tumor	Monitor nutritional Instruct the client about diet changes that make eating easier (Soft and high caloric diet)
Gastric Cancer	A malignant growth of the mucosal cells in the inner lining of the stomach	> 50 years old	Early: Indigestion Abdominal discomfort Full feeling Epigastric, back, or retrosternal pain Late: Weakness and fatigue Anorexia and weight loss Nausea and vomiting Pressure in the stomach Ascites Iron deficiency anemia Dysphagia and obstructive symptoms Link	Chemotherapy Radiation therapy Gastrectomy: Total; Subtotal: Billroth I and II	Monitor nutritional *DIET:* Soft, small frequent meals, bland )
Pancreatic Cancer	Highly malignant, rapidly growing adenocarcinomas originating from the epithelium of the ductal system	> 55 years old	Clay-colored stools "Acholic Stool" Glucose intolerance Abdominal pain Jaundice	Nonsurgical: Chemotherapy Radiation therapy Surgical: Whipple procedure	Monitor blood glucose levels (hyperglycemia or hypoglycemia) Monitor nutritional status *DIET:* Soft, high fiber, high protein, small frequent meals)
Intestinal Tumors	Malignant lesions that developing the cells lining the bowel wall or develop as adenomatous polyps in the colon or rectum	> 50 years old	Early: Blood in stool (most common manifestation) Anemia Weight loss Late: Guarding behavior, abdominal mass, cachexia (severe muscle wasting)	Nonsurgical: Chemotherapy Radiation therapy Surgical: Bowel, local lymph node resection Colostomy Ileostomy	Monitor for signs of complications, which include bowel perforation with peritonitis, abscess or fistula formation, hemorrhage Pre-op Care: Instruct the client in prescribed preoperative diet; Intestinal antiseptics and antibiotics may be prescribed, to decrease the bacterial content of the colon Post-op Care: Colostomy Ensure colostomy care Monitor the pouch system for proper fit and signs o fleakage; empty thepouch when one third full Monitor the stoma for size, unusual bleeding, color changes, or necrotic tissue Normal stoma color: RED or PINK, indicating high vascularity. Appearance: Shinny, moist, no lessions, some bleeding is noted Stool Characteristic by region (DATS) Descendinng colon: Close to normal Ascending colon:Liquid Transverse colon: Loose to semi-formed Sigmoid colon: semi-formed to formed Administer analgesics and antibiotics as prescribed. Instruct the client on how to resume normal activities, including work, travel, and sexual intercourse, as prescribed; provide psychosocial support. Post-op Care: Ileostomy Healthy stoma: is Red in color Postoperative drainage: darkgreen to yellow as the client begins to eat. Stool consistency: Liquid. Monitor for signs of dehydration and electrolyte imbalance Link
Lung Cancer	A malignant tumor of the bronchi and peripheral lung tissue. Common target for metastasis from other organs.	65 - 74 years old	Wheezing Dyspnea Hoarseness Hemoptysis Blood-tinged or purulent sputum Diminished breath sounds	Nonsurgical: Chemotherapy Radiation therapy Surgical: Laser therapy Thoracentesis Pleurodesis Thoracotomy Lobectomy	Monitor breathing patterns and breath sounds Monitor for hemoptysis Assess for tracheal deviation *DIET:* high-calorie, high-protein, high vitamin diet Administer bronchodilators and corticosteroids Place in a Fowler’s position Monitor VS Monitor bleeding, I&O, and respiratory status *Priority: Airway
Laryngeal Cancer	A malignant tumor of the larynx	> 50 years old	Hoarseness Painless neck mass Feeling of a lump in the throat Change in voice quality Hemoptysis Foul breath odor	Nonsurgical: Chemotherapy Radiation therapy Surgical: Cordal stripping Cordectomy Laryngectomy (partial/total) Tracheostomy	Pre-op Care: Discuss self-care of the airway, overall support system Encourage the client to express feelings about changes in body image Describe the rehabilitation program needed during recovery period Post-op Care: Monitor respiratory status Assess gag and cough reflexes Reinforce method of communication ( speech rehabilitation) Observe for hemorrhage and edema in the neck Monitor IV fluids or parenteral nutrition until nutrition is administered via a nasogastric, gastrostomy, or jejunostomy tube Reinforce information regarding stoma care following laryngectomy. Link
Prostate Cancer	A slow growing malignancy of the prostate gland; common cancer in American men	> 50 years old	Early: Asymptomatic Hard, pea-sized nodule (DRE) Gross, painless hematuria Late: Weight loss Urinary obstruction Bone pain (lumbosacral area to the leg)	Nonsurgical: Androgen suppression therapy Luteinizing hormone therapy Radiation therapy Chemotherapy Surgical: Orchiectomy Prostatectomy Cryosurgical ablation Transurethral resection of the prostate (TURP)	Post-op Care: Monitor I&O (urine, bleeding or blood clots) Increase fluids to *2400 to 3000 mL/day* Expected: red to light pink urine for 24 hours, amber in 3 days Monitor for transurethral resection syndrome or severe hyponatremia (water intoxication); S/Sx: HTN, Bradycardia, confusion, altered mental state
Bladder Cancer	A papillomatous growth in the bladder urothelium; noted malignant changes; infiltrates the bladder wall.		Painless hematuria (most common sign)* Frequency, urgency, dysuria Clot-induced obstruction	Nonsurgical: Chemotherapy Radiation therapy Surgical: Cystectomy TURP Ileal conduit Ureterostomy Urostomy	Pre-op Care: Instruct the client regarding the diet, medications, nasogastric tube placement, IV lines, NPO status, pain control, coughing and deep breathing, leg exercises, and postoperative activity Educate about stoma care Arrange an enterostomal nurse consult and for a visit Post-op Care: Assess stoma (should be red and moist) every hour for the first 24 hours. Monitor for edema in the stoma; may be present in the immediate postoperative period. Assess bowel function Monitor for bladder distention following a partial cystectomy Instruct theclient to assesstheskin for irritation, monitor the urinary drainage pouch, and report any leakage Provide emotional assistance General Ostomy information: Link Link Link

Oncological Emergencies

Sepsis is a life-threatening illness caused by your body's response to an infection.

Disseminated Intravascular Coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels.

Interventions:

Early identification of clients at high risk for sepsis and DIC
Maintain strict aseptic technique
Administer antibiotics and anticoagulants as prescribed

Priority: Hemorrhage

Syndrome of inappropriate antidiuretic hormone (SIADH) causes the body to retain too much water by stimulating substances that mimic antidiuretic hormone.

Signs and Symptoms:

Weakness
Muscle cramps
Loss of appetite
Fatigue
Hyponatremia
3Cs (coma, confusion, changes in personality)

Interventions:

DIET: Limit OFI, Increase Na intake
Administer an antagonist to antidiuretic hormone
Chemotherapy

Spinal Cord Compression occurs when a tumor directly enters the spinal cord or when the vertebral column collapses from tumor entry, impinging on the spinal cord.

Signs and Symptoms:

Numbness
Tingling
Loss of urethral, vaginal, and rectal sensation
Muscle weakness

Interventions:

Administer high-dose corticosteroids
Chemotherapy or Radiation therapy
Use of neck or back braces

Hypercalcemia a late manifestation of extensive malignancy that occurs most often with bone metastasis.

Signs and Symptoms:

Fatigue
Anorexia
Nausea and vomiting
Constipation
Polyuria

Interventions:

Monitor serum calcium level and ECG changes (shortened QT/ST interval, wide or flat T wave)
Administer oral or parenteral fluids as prescribed
Prepare the client for dialysis if needed
Encourage ambulation

Superior Vena Cava Syndrome occurs when the SVC is compressed or obstructed by tumor growth (commonly associated with lung cancer and lymphoma).

Signs and Symptoms:

Early: Edema of the face esp. the eyes
Strokes' sign ( tightening of shirt or blouse collar)
Late: Edema in the arms and hand
Dyspnea
Erythema of the upper body
Epistaxis
Alarming signs: Airway obstruction
Hemorrhage
Mental status change
Decreased cardiac output
Hypotension

Interventions:

Place the client in semi-Fowler’s position
Administer corticosteroids and diuretics as prescribed
High-dose radiation therapy to the mediastinal area

Tumor lysis syndrome occurs when large quantities of tumor cells are destroyed rapidly and intracellular components such as K+ and BUA are released into the bloodstream faster than the body can eliminate them.

Signs and Symptoms:

Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia (acute kidney injury)

Interventions:

Encourage oral hydration
Monitor renal function and intake and output
DIET: renal diet low in potassium and phosphorus
Administer diuretics and antihyperuricemia meds as prescribed
Prepare to administer IV infusion of glucose and insulin to treat hyperkalemia.
Prepare the client for dialysis if needed.

Anaphylactic Reaction an acute allergic reaction to an antigen to which the body has become hypersensitive.

ASSESSMENT	SIGNS AND SYMPTOMS	PRIORITY INTERVENTIONS "ABC"
Obtain an allergy history	Dyspnea (Tachypnea)	B: Assess respiratory status
Administer a test dose when prescribed	Chest tightness or pain	Stop the medication
Monitor vital signs	Pruritus or urticaria	Contact the health care provider (HCP) and the Rapid Response Team if necessary
	Tachycardia	B: Administer oxygen
	Dizziness, LOC	Maintain the intravenous (IV) access with normal saline
	Anxiety or agitation	C: Raise the client’s feet and legs, if not contraindicated
	Flushed appearance	Administer prescribed emergency medications, such as epinephrine (Epi-pen, Prednisone, Diphenhydramine),
	Hypotension	Monitor vital signs
	Cyanosis	Document the event, actions taken, and the client’s response

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Oncological Disorders NCLEX Review

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