difference okay so in college here I told you and I'm giving you a round guesstimate right so with the intology question they're looking at anywhere between 10 to 12 questions and now when we say 10 to 12 questions listen to me very carefully you have this whole story you know the basics right you can take that patient scenario and be able to disciple what's the new places we're going to talk about some of the emergency conditions which you're going to see on the exam that I really need to make sure that you know can you understand why a really um um we already know what cancer is right the disease process the cells are proliferating abnormally it's a malignant disorder uh there's a genetic component it could be localized it could be invasive metastatic cancer back to pathophysiology but this is not pathophysiology so I'm not going to ask you those basic pathophysiology questions the questions are going to focus on the patient and patient management with those disorders right so just a a quick Uncle jeans or your normal jeans that help to regulate growth and repair your proto-uncle jeans acts as a switch in that case and then you have your tumor suppressive genes acts as the off switch but in cases where it fails we have these cancerous states that take place makes you know the difference between what's considered benign versus what is considered malignant what's considered cancerous versus non-cancerous because you can have a tumor growth and a tumor growth be considered benign because it's non-cancerous it's not expected to invade you know other cells or other organ systems so makes you know the difference between the two malignant versus benign terminology there are different stages um of Karen so you have that initial stage where there's damage to that DNA so it's damaging a specific Gene there's permanent mutation that takes place you have the promotion stage where those carcinogens are introduced resulting either in reversible or irreversible damage does anybody know which type of cancer that when it's finally diagnosed it's usually and it's later stage by the time the patience pancreatic cancer is one of those cancers where they're when they finally get that diagnosis it's usually late in the game and there's nothing that they can do for that patient I think that's Patrick Swayze another common unfortunately common cancer that we've been seeing a lot of and they've been highlighting because within the celebrity Community there's been a lot stomach is holding cancer so we had the initiation we had the promotion of that cancer and then it started to progress right it gets invasive there's neovascularization so Invasion invasive um invasion in the cardiovascular system um and then tumor the development of additional tumors within the system right so it progresses and in metastatic metastatic it spreads it spreads so um I don't need you to know the the detail of how it spreads just know that metastatic cancer is the production of secondary tumors at a distant site right patient initially started off with colon cancer and they have developed stomach cancer but that stomach cancer was not the initial cancer diagnosis it's the additional or the secondary cancer as a result of the primary so Sykes the most common signs for metastatic cancer the bone the lung the liver essential nervous system and then the causes now here's a here's the thing I I love to bring up when it comes to exposure to radiation exposure carcinogens we know different chemicals can be considered carcinogen right different um occupational chemicals that patients get exposed to the community to the chryslerogenic exposure to radiation now you're like who's exposed to radiation that's right X-ray techs are and maybe the its are when they're working on The Radars they're supposed to wear or the antennas there's some protective gear they're supposed to wear protective care back to the X-ray text do you see all of them are protected here and here you are like hold on let me get out of the world because I don't want to get exposed to any of that and it's concerning here's the other thing where you think about explosion to radiation you have a patient who already has cancer right and you're getting radiation therapy for one type of cancer I can't I know when you think about it it can develop another cancer as a result of exposure to radiation to treat that primary cancer right chemical carcinogens genetic factors right patients who are risk genetic wise dietary factors now I'm hearing dairy products right okay and red meat right that list will be a lot longer maybe actually evaluated right because now I think there's one company um this isn't the process because they said they could they could help with Hunger a certain percentage of the population with Hunger they're actually taking the cells of meat and reproducing it in the lab to create you saw that let me yeah it's something weird but they take it out of this Frozen system take the cells it can be reproduce the cells to now create chicken meat or beef meat right it's about like two thousand dollars right now because it takes so much work just to reproduce it that's the beers um land protein there's so many companies that are advertising this replacement meat in these plant products and that's even iffy right there because there's chemicals involved with that hormonal agents estrogen therapy right estrogen therapy is one of those hormonal agents I can place um a patient at risk for who's on estrogen therapy that's correct so one of the key um types of cancer we're going to discuss is your breast cancer right so risk factors associated we're looking at age all right female gender but males can get breast cancer absolutely all right dense breasts family history personal traits early menopause no children or one child after the age of 30 late menopause so many risk factors associated not breastfeeding lack I always have to make sure that there's a reason why emphasizing that not breastfeeding lack of breastfeeding meaning with child but not breastfeeding choosing to provide formula okay yes yes lack of breastfeeding you can place a patients I know when I learned that also greatly what you call your father like hold on so hormonal replacement therapy sorry ethnic groups you know we're colon cancer among the African-American populations what iris alcohol consumption now this gene mutation so you know the story of Angelina Jolie getting um prophylactically yeah because of this gene mutation which places her at high risk for breast cancer so you have some people who are just in advance just take them out a lot of patients will get hysterectomy insurance companies paying for it they're looking at the end what's going to happen but do know that increased age is the primary risk factor for both men and women for breast cancer this I don't need to go into detail and you know what your immune system is supposed to do right it's supposed to service to surveillance protection from different types of cancerous abnormal cells it fails as we get older our immune system is not the same then you think about certain illnesses that can compromise your immune system there's one common chronic condition that a large percentage of the population has that can cause huh I heard it diabetes diabetes that can compromise your immune system cancer cells can shed and then there are medications that can also um cause issues with the immune system immunosuppressive therapy immunosuppressive drugs all right can cause that your steroids most popular one is steroids radiation can suppress your immune system also so you have a patient with cancer and they're getting radiation therapy for lung cancer they need their immune system to help fight on a lot of these disorders get the treatment for that cancer and supports the immune system yeah so in a system the body fails to recognize these abnormal cells all right it can't differentiate it from self and it allows it to continue to multiply right allows ourselves to continue to multiply a beautiful transition of the PowerPoint it's taking too long so what's the basic things that you need to know with the oncology section right your role as a nurse caring for the patient you're the nurse educator there are different things that you're going to do primary prevention when you think of primary prevention it involves reducing this makes you know the difference reducing the risks all right you're teaching your patient when you're doing your initial um tell them physical assessment and you're asking specific questions if you notice during the admission process do you smoke do you drink how often how many packs have become so small smoking what type of liquor do you drink do you drink you know all of these key things that we're taking in into place so that when we're educating our patient before discharge we're telling them about the different risk factors and what they can do to change methods to avoid um STDs because frequent STDs can also I should say STIs because STDs is no longer the term um sexually transmitted infections can also lead to cancer cervical ones so that's primary before anything has happened right primary prevention now secondary prevention what's the goal of secondary prevention forces or prevention and screening what was that early detection early detection so it's specific specific so with our secondary prevention of breast cancer we're teaching our patients how to perform self exams with our male patients testicular exams um even with our male patients who might have a history or a high risk still teach them to do self exams right or to be able to identify any animal and Pap smears pap smears used to be recommended on a yearly basis but now what I'm seeing with a lot of them I don't listen to that colonoscopies you have to the age of you know at what age family history yeah 50 range but if you have a family history but early even now at four years 40s with the mammogram oh and they and they actually gynecologist primary care physician actually pushed heavily to make sure if you're around the age of affording tip that you have your mammograms [Music] so teach the patient the warning signs of cancer so I'm going to talk a little bit about caution makes you know this because you notice I put it in the folder right so change in vowel or bladder habits and it's the weirdest thing because when a patient comes and they'll tell me something simple I've noticed that I had a little bit more difficulty urinating than usual and it's been happening for a couple of weeks pictures of prostate issue and sometimes it ends up being like an advanced issue or my I normally move my bowels on a daily basis two or three times a day and it's been less frequent right every three four days or once a week you hear that from patients where it doesn't alarm them especially within any Community where they're not rushing to go get preventative care it doesn't alarm them they continue to uh live with that until we get to the point where they're being diagnosed with some invasive cancer a sore throat or sore should say that doesn't heal unusual bleeding or discharge a lump in the breast or elsewhere eye for indigestion or it's difficulty swallowing obvious change in warts and then what you'll see now is part of the preventive primary care they'll recommend that the patients go and see a dermatologist I won't forget what he said we recommend the insurance company only sends it out go and see a dermatologist like what you have nothing for the Dermatology they just do a full body scan they find any little spot that's exactly what they do any little spots and so we need to keep an eye on this spot next one and I had one young lady who told me a story about um her father she took a class about her father she said he had a spot on his foot that almost looked like an ink spotted but the family was really not paying yeah and basically they weren't paying that much mind to it until by the time they finally went in to go get a check it was already yeah that's the size it was really some really invasive so those early primary and you know secondary preventative measures are very important even for the minor things that the patients might think it's it's not going to worry about but I've heard it time and time again it was something simple that they saw they didn't really think too much about it and by the time they went and saw care it had already gotten into a late stage of it and nagging off our horses tertiary prevention the care and educator provided after the the cancer has been diagnosed so that Continued Care that continued follow-up care now with tertiary prevention um I think I go into it into the next the goal is to keep our our patients diagnosed with cancer as healthy as possible educate them on the different types of treatment and to continue on and maintain that treatment but I always say um in some patients I've found that even at a young age they've gotten to a stage where they're just tired of the continued treatment and I usually have to get to a point where you respect your decision not to receive treatment we can't force treatment on our patients actually recently um in her late 50s chin invasive colon cancer and she was receiving aggressive chemotherapy as children grandchildren you know a lot to live for but she got to a point where somebody she got to a point where she was just tired and just ready to give up and didn't want to have to do it anymore so what I have to explain to which is difficult for any family member to have to go to religion but I have to explain to her son is in a way with being sensitive um because I've seen a lot of patient is suffering to some of these stages that you need to take those moments with your mom and enjoy every single second because not everyone has that chance to spend time with their loved one before they pass and some people lose people suddenly so take those moments stay whatever he was at her bedside so that moment she took her life spread at home it's difficult for a lot of people so diagnosis how can that be done by biopsy could be an incisional biopsy excisional biopsy where they're removing a portion of that tumor and the surrounding tissue needle aspiration biopsy right where that's sent to the lab and that can give us the extent of the disease now I'm not going to ask you any questions on staging right my belief is that when I'm questioning you on material when it comes to nursing it's actual material that you're going to actually use as a nurse out there in the field but do know that there's a whole staging system that is used where t-n-m um extent of the tumor absence of presence if it's invading into the lymph node itself and um if there's any distant metastasis that come to it or do know that there's a staging system there's also a grading system am I going to ask you questions on grading no but don't know that there's a whole grading system when it comes to the diagnosis of yeah so what to treat so they're going to review the um clinical data that's collected with the biopsy the labs all of those um information and when they make the decision to treat the the cancer where's the site of the cancer review the client's history do they actually qualify that for that specific treatment that they're supposed to receive thorough physical exam Radiology exam and then lab data is being used now this you need to know the goal of therapy right what's the goal of therapy cure is one to completely eliminate the cancer that's one goal control meaning we can't cure this cancer but we're going to control the growth of that or eliminate any um issues that might take place where it might metastasize so they might have um radiation therapy just to decrease the size of that cancer or palliation making the patient come comfortable and I'm going to explain what I mean by palliation therapy the patient might have surgery for a cancer that's not curable that's going to metastasize and invade other organ systems but let's say it's putting pressure on a vital structure of the body so they're getting surgery not secure or get rid of that cancer just to alleviate make that patient more comfortable foreign so surgery could be done to diagnose it could be used as primary treatment to remove portions or the entire tumor and then prophylactic surgery the example that I gave you was with Angelina Jolie where she didn't actually have the diagnosis but she had that genetic genetic risk factor so then she had the mastectomy done and palliation but I just explained a little while ago because these are some of the issues that can take place even though we're not curing a cancer the cancer they might have could be you know ulcerations obstructions it might cause Hemorrhage it might be causing pain for the patient and then reconstructive this surgery the insurance company pays for so a lot of times what they'll do you can see in this case where it's before they remove the the breast and they close the incision site what they might do in order to place an implant later on is put what they call a tissue expander almost like a balloon type structure where they slowly expanded to stretch out the tissue in order for them to place that implant in foreign a lot of our patients especially if they have increased risk factors might not even opt to go for that reconstructive surgery here's a key question I'm going to ask you down on the phone can you see this in front of me nursing management you have your patient that had a right breast total mastectomy with lymph node removed and your blood pressure no this already right no blood pressures no lab work we're going to educate the patient on this so that when they're going less into an outside lab or going for their regular physical appointment so they can instruct that provider you'll notice patient goes oh no you're not supposed to take my blood pressure over here right I had my breasts removed you might not notice that because maybe they have that implant done right so make sure to educate and then when your patient comes in the hospital with a right mastectomy or you can't use that limb what do we place on the patient right it's usually what color everywhere foreign so after surgery we're going to make sure we monitor for post-op complication now when we think of prioritization of issues post-op what's your major issue hammering hammerage right but the other key thing I'm going to tell you pertaining to Airway immediately will stop because the patient still has sedation on board we're going to make sure that Airway breathing is also cared for then assessing the site for bleeding I'm going to give you an example of a bleeding that pisses me off every time I talk about it oh sorry my daughter had um it was benign uh they found uh lumps in the thyroid right I also happens but they're very minute not growing enough to cause an issue but hers it was benign but it was growing in a way where it was starting to cause issues with her Airway so she had to get a total um thyroidectomy done now she's living on syndroid for the rest of her life but I didn't appreciate though um post-op it was taking a little while before they let me back then I was trying to be a mom and not you know a nurse and like a rush back there um she wasn't ready she wasn't ready for visitors that was very concerned about it and I was trying to not act like the angry Iration you know family member that they left sitting in a waiting area anyway somebody came to me and told me that they had to rush her back to the operator it's not what my daughter told me she told me the whole story she said Mom I came from surgery I was having a hard time breathing and she said they kept telling me I was anxious to calm down and then that they were trying to give me something to help me calm down and she kept saying I'm having a hard time really and I can't breathe I'm not anxious having a hard time breathing and she said she kept me all the time so she was hemorrhaging from that side so that bleeding is filling up and applying pressure to Burnt Airway so they took him a while because she's no she's well aware I can get her too she said it took them a while before they finally brought the anesthesiologist into the room so come and assess me and realize that they needed to the first dangerous things post on the look for any signs or symptoms of post-op hemorrhaging and it kind of skipped out she said mommy just kept brushing my nose just kept brushing it very simple very simple basic assessment I've heard so many stories and issues where something could have been caught early on and it was a complication that's known that can happen as long as you know to pick it up and inform the position right away so I just have to emphasize that make sure that you assess for hemorrhaging whenever you see a question that's asking you about post-op complication and in your mind you go in fact right now so infection takes some time to set in not prioritizing infection now but I'm gonna make sure that I keep the patient free of anything that might cause infection so it's just like prioritizing an actual problem instead of I don't know that's correct that's correct that's one one part I see when when I see students struggle with those type of questions where you think an infection right away because it's a operative site an incision think about those current present things that are happening so of course with nursing management um patients emotional support is very important I worked at um Community was in a Community Medical Center or Moses Taylor Hospital in Scranton Pennsylvania I used to work on the oncology unit I worked with supply for research again except for neonatal ICU maternity that wasn't my thing um on the oncology unit circle different things the emotional support part is very important you have to think about this as when you get that use it's a loss so they go into all of the staging stages of grief of grief you have to respect that and be able to support the patient and I usually tell some nurses that if you have a very angry patient don't take it personally that's the way some patients cope when they get those type of news they might lash out I'll be angry just you know kind of give the patient a space I was telling someone I won't forget passing by run one room and it wasn't even my patient and this woman was just a question someone kept telling me to go in a room and talk to her and in my head I'm fighting internally it's not my patient it's somebody else's patient it was like something was nudging me to go into that room so I went into the room and I and I asked the patient if she's okay and then she started spooling out you know opening up and spilling out so that therapeutic um communication took place how she was just diagnosed with um I remember exactly what cancer she had the doctor pretty much just came in told her to Medical term no terminology just spoke all medicine and walked out that's about it she didn't know any other information it wasn't broken down for her in layman's term but she didn't understand and I remember saying to her I'm about to take a lunch break give me a moment I'll come back and talk to you printed out some basic information on her diagnosed and sat with her and then went over everything just broke it down held her hand Let Her Cry on my shoulder and then that was that and as she said to me her family had come in to visit later on that day and I was passing by her room and she said to my her family that's the nurse that's the nurse that came in to help me out and if the family was like all happy and she said I was in here crying and praying to God if somebody can give me I'll come and give me an answer or something more solid with this because she said she had no hope at that moment and she said at that moment while she was in the middle of a prayer that nudge stuff was pushing me because that was not my patient and I started talking to her in a way where it wasn't my speech where I would give to a patient so I found that weirdness creeped out by it at the end of the day I was kind of creeped out by it stop I know that that gave me I was creeped out by it but that that moment is what she needed and I was kind of pushed in so that emotional support and I see that time and time again patients are given here's what you got deal with it and nobody sits down and talks very important that tool is important when it comes to healing for that patient it's very important when it comes to humanity okay so radiation therapy we already know that it can cure control can be used as a palliative can be used as prophylactic um measures but it can also cause cancer right so it's toxic that we know it can alter Skin Integrity it can cause Burns it can cause hair loss dryness of the mouth don't ask me to pronounce that word I could never all these years are stones zero stomia right it cause nausea vomiting irritation to the esophagus um with the bone marrowness one key important thing that you need to know right with the bone marrow it can suppress the production of those blood cells because myelose suppression because we're going to talk briefly about some sort of blood cancers that can be caused as a result of radiation so again you as a nurse You're Going to educate your patient educate the the family if they have the radioactive implant not too many of you will be working on oncology but if you're on oncology and they have the radioactive implant usually we have a sign that's on the door stating that the patient has a radioactive implant usually we don't assign nurses who are pregnant to patients with those radioactive radioactive implant because what's the what's the medical term again for the tea that can be pronounced so you're going to assess your patient thoroughly their General well-being their emotional well-being and then we have chemotherapy right again same thing cure control can be used for palliation it eliminates the marrow resulting um eliminates those cancer cells but it can cause deficiency in your red blood cell so if you know that chemotherapy can cause deficiency or issues with the red blood cells what are some of our concerns oxygenation obstinations because that hemoglobin or the oxygen carrying capacity of their blood foreign platelets bleeding I put um this keyword or this definition I think in um in the fold extravastation because what's the other thing the infiltration right you hear infiltration of IV but some of these medications um serve as vesican it can destroy the tissue and that's what I'm going to make sure that I have somebody from a legal nurse consultant that's coming it's going to show you a couple of those pictures of those medications that extravisated in the patient and destroyed ultimately destroyed their tissue causing necrosis of their arm or cause them to lose a limb even they can have allergic reactions to this it can be toxic to the other organ systems cognitive impairment uh fatigue Your Role again as a nurse right it's the same thing regardless of the disorder physically caring for the patient manage their symptoms if they're nauseous vomiting we're going to give them one so friend is what's the what's the generic name okay yes so Fred and there's also another common one that they get you know what such an argument right what's the generic that's an m [Music] again the only reason why gold what's a generic is because when you're looking at the NCLEX for some of those uh it is going to stick to generic because the same test is given in Australia and in Canada so this is why they're not using the brand name thanks so again education psychosocial management educated you notice there's a lot of this information I tell you to educate of course you guys by now already know your electrolytes and all the issues that you pause um you're going to monitor their Labs you actually vomiting infection and that was great because I asked you earlier about infection precautions and you were able to bring that up mucositis inflammation of that oral mucosa cognitive status you're going to make sure you do your neural check on that patient so as far as treatment some patients might have bone marrow transplant completed also known as stem cell transplant it can be used to treat malignant or non-malignant disease terminology again alogenic from a donor other than the patient allergenic donor other than the patient autologous whenever you see that turn it's coming from cells right just to let you know patient can do an autologous blood transfusion did you know that yes yeah and syngenic from an identical twin don't say that often right but from an identical twin that can be quote so usually from the iliac crest the peripheral blood is now a major stem cell um a source for stem cell for transplant where else can be a source oh it's the same same area but besides um besides taking from it's controversial placental is one umbilical quite relaxed so you know that now that you can you have the option to store that umbilical cord but so for you you're going to practice prep the patient eradicate disease via high dose chemo chemo and um radiation I'm not going to ask you to memorize any of this stuff for the test right but the key thing that I do do need you to know is there's a weight period for the stem cells to produce new blood cells right the main key things during this whole process that you need to put monitor the patient for is there a risk of fatal infections right risk of fatal infections so what's the basic things you're going to do nurses wash your hands then we're going to teach here's the other thing here's the other thing teach the family no plans no flowers usually no fresh fruit um no no raw meat no sushi nothing usually when I do when they come in with the flowers don't go anywhere with that I might stay at the door and show the patient the flowers and then give it to that family member to take it back or they might say you know they want the nurses to happen they can't have it in a room the whole isolation thing especially when they're on those type of precautions so you have to keep in mind again the emotional status of that patient you got a question um what's pan side toppedia decrease in everything very good right so again we put on post cell transplant this can cause us a severe complication decrease in all of their blood cells pansytopenia right so just ask yourself if there's a decrease in the white blood cell what's going to happen red blood cell what's going to happen platelets what's going to happen what's the effect of that this is definitely a question graft versus host disease right so the pathway behind it your donor T cells recognize recipients tissue as foreign and attacks it right you see this in transplants also right it's difficult to treat they try to give immunosuppressant drugs days before the transplant and what do you see in these patients rash blisters abdominal pain diarrhea liver injury and this can happen within 100 days okay so week one two they might be fine but later down the road now they're having this disorder graft versus host disease this is also known as like when they're rejecting or they're yeah because think about it same thing right foreign body so treatment why steroids so suppresses immune system suppress that whole response very good but it's very difficult to drink here's an example of that it's painful people compared to having a burn all compared to having a bar right very painful because Silence of stomatitis just think inflammation of that oral um region of the GI tract or the GI cavities this can happen within 5 to 14 days after treatment how do we manage we're teaching and educating the patient we're providing good Oral Care but are we going to use uh Listerine with alcohol in it absolutely not right teaching good oral hygiene avoiding alcohol mouthwash treat infections immediately and then they can even give um lidocaine to numb to help deal with the pain is this for chemo or is that for the transplant sometimes that's what chemo this is expected yeah yeah so expect the side effects that can take breaks I know it doesn't occur in all the patients okay I'm happy you're dividing it between because those are usually tough when it comes to exam questions when you're looking at what's expected versus what's an adverse event and in this case if you know stomatitis isn't um expected would this be like a rapid response you know issue no if simple things that we can do to manage them just so we'll see what you see model suppressions when you're getting this treatment you know it's going to suppress the immune system it's going to suppress the production of those blood cells decrease white blood cells that's expected that that can happen so what are you going to do as a nurse you're going to put the patient on that reverse isolation or neutropenic precautions right protect the patient from all of us okay if you know to decrease red blood cells all the signs and symptoms associated with anemia right you're going to treat the patient but infection is the leading cause of death in this case now this rolls into when we go into the hematological not the oncology human intelligence disorder but we'll be talking further about hematological disorders but make sure that you know all the signs and symptoms associated with um anemia decreased red blood cell red blood cell count decrease blood volume you know what you expect to see in that patient why are they tachycardic again you know um so she's going down into angiotenser and wanted to so short and some breath headache dizziness irritable hail how do we manage you did not forget your whole blood transfusion no all right that did not go away because that's never going away right signs and symptoms of anemia that we need to teach our patient and of course they're going to be ordered blood transfusion depending on what component of their blood they're like right make sure we know the Baseline so the next couple of PowerPoints is focuses on some of the key basic things that you know right white blood cell count what's the purpose of the white blood cell count what's the lifespan of the white blood cell count I'm not gonna it's not anatomy and physiology or patho again I'm focusing on Med search but you need to understand this part if you don't so neutropenia because I need you to pay attention there's a reason why um increased risk for infection especially especially when there's a reduction of the absolute neutrophil count a thousand or less don't forget that reduction in the absolute neutral flow count a thousand or less the patient is at risk for infection this breaks down the absolute neutral count and I'm not going to ask you to calculate any of that just so that you can have a better understanding of how that's done so what's your role you all know this by now you're at the end and about to head out the doors nurses right obtain monitor the lab and assess for induction educate the patient about signs and symptoms and administer antibiotics as a per order anti-pyretics as ordered you notice this just keeps showing up all over the place I can't tell you how many times in the question where students will go like but that's such an easy response I can't absolutely be the answer has to be something more difficult it's not that difficult wash your hands basic washing it for everyone right restrict visitors who are sick and maintain adequate nutrition for the patient thrombocytopenia make sure you know what that is right platelets patients at risk for leading I'm just going to skip through the basic you already know what you need to do to assess for signs and symptoms of bleeding in the patient other issues the patient might have skin integrity because of radiation so they have skin burns alopecia was done hair loss of course management manage Innovation emotionally individual's life's name my wife's name right so we talked about anorexia difficulty with absorbing nutrients if the patient can't take pill food or fluids right because they have let's say severe mucositis you'll throw back pain what other options are there for nutrition total to Horizon nutrition they might not even do well with the the insure it's because they might still have pain so usually tpn they try to use it but it's only temporary you can't use CPN and some lipids along with that temporarily if it's that bad then they might need uh G2 plus implication can sense because there's some patients that would not consent and they'll slowly start themselves to them I know added difficult decision to make for one person when it came to G2 add an elderly lady who gave me over her care of attorney and healthcare proxy and she told me absolutely no eating too which was at home absolutely no feelings I ended up having to put in a nursing home because I couldn't take care of this in my mind but I pretend like it was me but I was like they can't even enforcement on the nursing home now from the nursing home I had to tell them they'll feed him so I need to follow her wishes because At first she wanted to die at home by herself I could not allow that you're feeling too but now the nurse is called me gave me this guilt trip they said she's coherent she's talking inside she's watching me so much and I thought that she would pass away sooner than later months was passing she's just initiated and now she was in bed forming bed sores and the bed stores around healing because she didn't have enough nutrition so then the position called me on the phone they said this is what you know this is horrible I'm like I'm trying to respect coalitions but does she really English and said to me I said all they did they put it to me I didn't know what the doctors must have done that anyway she was after she had the tubing she lived for another year plus in the nursing home watching whistle soap operas weren't as bad the infections weren't as good I know but she had nutrition but building over the new herd because we've been in and out of the nursing home before and they said they were like watching their start for death and it was very very difficult for them does she really understand okay I know that's that's difficult I feel uncertain standpoint when I'm talking to families and then asking them to make that decision for that family member very different so this just breaks down pain assessment the different drugs of choice you know we're going through we've been going through this major opioid crisis and what is that that series that they had did you watch it oh thank you don't set quick breaks down all the issues that's been taking place as a result of this opioid crisis um Dilaudid attention Dilaudid is a very powerful drug then he said 100 times more potent than morphine it was meant for cancer patients really ill cancer patients and unfortunately with Pharma big Pharma they realize that they could make a lot of money from this drawing so there's a bunch of you know deaths that could have been avoided even there was a young lady I think teenager who had a fracture and needed pain medication and that's what they started her off on and instead of trying to lead her off they kept the pharmaceutical company kept saying you can double the dose they doubled it they said you can go up a little bit higher until they had patients on this ridiculous ridiculous amount because they were building kind of resistance to the drug and required a lot more you know it's been weird I had a surgery and I thought that but um Island was working better than that and he should have started with something more simple and then increasingly gone to something more complex if your pain could not be mad and it's turning done all right off the surgery and then on and then that but I I personally I didn't like it it's just one second then the next segment is I actually had a patient recently that decided to work with my HSS so I worked in the Outpatient Clinic so we I was in pain management and I had a patient who came in and was like you know the doctor is prescribing Percocets but it just doesn't work anymore so being those I'm like well what do you mean it doesn't work anymore he said it started off with one pound and now I take two and I'll take it four a day so my head I'm like you put me resistance and he doesn't even know it so I told the doctor and I said look you're going to go under my negotiation and who's taking 45 a day because he's like the cricket doesn't make you feel anything long story short his you know his daughter came into that appointment with him and ended up having to take him to rehab because I think it's Percocets and I had no idea so there's a better approach to pain management pain management and some of the hospitals you have your pain management uh person that comes in a nurse usually and then finds other types of therapy to combine Tylenol combined with you know Gabapentin it also hits certain pain receptors liver cup which is used for seizure so they're also increase certain pain receptors they can combine it when I worked um in the packing heavily a lot of times of course they'll order these heavy duty Fentanyl and and morphine what I found was with certain patients if it's not contraindicated there was either Toradol they have IV ibuprofen and they have IV Tylenol right so before the patient even completely wakes up I'll start giving them those meds I saw a big difference between the patients that I didn't pre-medicate with those lighter drugs versus those who started full-blown narcotics and so he mentioned that because my father-in-law he was in the ICU 85 year old male he actually got um spinal surgery he had scoliosis so he had six pins but in his back and then he had a herniated tube herniated discs really badly where it caused a weakness in his left foot so he was dragging his left foot but when I was I was the nurse in the hospital with him and in ICU I was there every day um but you know I was concerned because his vitals were elevated and he kept complaining of pain so they started off they wanted the PA came up didn't even really assess him and was like just give him Dilaudid and I said to the PA I said with all due respect I don't want my father-in-law on Dilaudid because one he's elderly two he is he has never taken any narcotic in his life in his entire life but we don't really know you know so why don't we start starting off with something like oxy or perk something something you know easier more mild on the body because he was just like yeah just give him Dilaudid it's fine and I did I had to advocate for him the entire time he was in the hospital he was tachycardic he was running a low grade fever I told everybody about this in lab like I that was my patient zero in the ICU doctors after walking stand I I don't care like like I don't care because I was the same way with my parents advocating advocating that like as a nurse you really do have so much power because I remember when I was there the one nurse said to me you know just because this is prescribed it doesn't mean you have to take it it's just not just knowing that how is your pain like assessing the pain and I'm like you know I'm gonna try and hold off and then slowly like but that just just like if you have a patient that comes out and they gave the patient a PCA pump for pain management but you know the patient is not really coherent or aware how to properly use it sometimes we need to Advocate and speak out this is not the appropriate about pain management for my patient as a nurse definitely education and advocate advocating so that's what we did we ended up I said don't you have anything like I because I knew of the Tylenol IV because I had it during a surgery so I said why don't we start them on like something really low with the oxy and then Tylenol to kind of supplement that because they did because obviously we want we still want to stay ahead of the pain but there's a way to do that to just giving them fix the Quick Fix right what patients call it the Lola they'll tell you about my patient who oh just about causes up to code because of her pencil patch oh okay I had a problem with a patient who kept asking for pain medication she set up her alarm on her phone and would follow me down the hall requesting her pain medication kind of cold in another room I was in the middle of doing compressions guess who came into the room to ask me for a gay medication this patient I just about blew my and then I had to go back into women's school tomorrow I was like you can't do that and I spoke to the physician I was like this is ridiculous the amount of response since you're giving station we need to do something else with marriages they're about to discharge our home she had a PICC line I can't remember exactly what she had to pick in life they were about to discharge her um home she wrote me a three-page letter about what how I'm improperly discharging home and it would give him Rapport Patient Care Management she didn't need to go she needed to go to read which is what she needed so anyway fast forward after I left my shift with a major headache because on this fellow room was just powder in her feet I almost took a fall in the room because of that the following day the nurses told me that patient quoted and I said what happened she had a fentanyl patch also right so what she did she ripped open the fentanyl patch she took a syringe from our parts right she pulled out DIY all right the medication from the fentanyl patch and she injected it into her PICC line it's like do you want to embolism right yeah material they brought it back came back I was like she better not be on my ass [Music] because I'm not doing this for nothing they transferred but I was African to say this something needs to be done about this patient but a lot of times a physician just kind of blows it through very important so I'm sure you learned about the different types of devices that can be used for IV infusion you're gonna have essential venous access device it can be percutaneous tunnel implanted or your pick line a lot of times they'll put pick listed under the central Venus access device along with um or sometimes they'll separate it but as far as care to the site you're going to treat it as you would your regular central line with the dressing change and making sure that you're using proper hand hygiene when you're proper glove changes and everything else there's also your mid lime catheters everybody's familiar with a midline candidate it looks like a PICC line but it's not it doesn't go as far up they can use a short term they can go home with that line so patients need medication ID meds from home they can actually teach them that the patient how to do their own IV meds from home or the home care nurse comes in and infuses the medication foreign of it you know we need to make sure especially if your patient is neutropenic put on that mask put it and you're putting a mask on a patient right for the masculine patient also when you're doing um care antibiotics you already know before you administer anybody in the Box you're going to do what 100 nation those cultures are sent out right as soon as that order is given after you do the culture we meet they do check sometimes they audit your chart to see how soon you gave the medication that was ordered especially your antibiotics delay in treatment can cause an issue let me see if anything else pertinent here's the other condition I want to make sure you know superior vena cava syndrome right so in this disorder just pay key attention he attention it carries we already know that the major vessels the superior vena cava carries that deoxygenated venous blood from the head neck and upper body to the heart right so with this there's an obstruction where this Venus blood from that upper portion of the body cannot blow into the heart so it's compressed and in turn this causes Venus pressure to increase and of course if you're not getting blood into the heart in the venous system your cardiac output is going to draw things are backing up and not moving forward right emergency it's gonna be facial swollen just think of anything that can take place if that blood is backing up in a proportion of the body facial swelling um redness edema in the eye swelling of the arms um and neck neck distension difficulty breathing hoarseness cyanosis and Strider Strider usually indicates some sort of obstruction late in the game visual disturbances dizziness change in mental status and the diagnosis is confirmed by chest x-ray CT scan MRI just know um that it's a medical emergency the signs and symptoms all right know the difference between that and something else I'm going to tell you treatment for this radiation chemo stents thrombolytic therapy especially if it's a um a block or occlusion blood occlusion and of course supportive measures oxygen steroids diuretics if needed nursing management I'm not going to read through this but look for patients with risk factors position them appropriately monitor fluid assess the difficulty swelling signs and symptoms of side effects from the medication that's provided spinal cord compression that's the other disorder right compression of the spinal cord so just think to yourself if this compression of the spinal cord number one what area of the spinal cord is this compression taking place number two what portion of the body is going to have some sort of malfunction as a result of this but um this can result in minor changes in motor sensory and autonomic function to complete paralysis so SVC was one spinal cord compression is another and these are complications what I'm sorry well I'm sorry what are you trying to relate this to pretty easy no I know that but I'm saying oh you're saying no these things know these things know these different complications right oncological emergencies the reason why I'm knowing I want you to know it is because if you come across a question and it gives you this patient presented with these signs and symptoms which one of these medical emergencies does this apply to superior vena superior vena cava syndrome that was one spinal cord compression that's another there's another main one um I don't need you to know the the treatments and they're going to test you on now so for a medical management of spinal cord compression we're just going to treat whatever issues the neurological um function control pain if the patient is mobile or immobile if they have bladder or bowel issues as a result of this um spinal cord compression what can we do to assess their bladder function s go back to the other one that's straight Kathy just say something yeah so you're doing the intake and output of the patient's not urinating you're doing a lot of scan first that's ideal before we go into straight cap symptoms a physician will give an order a patient does not urinate within so many hours straight count if 400 cc's of urine or whatever is is you know removed indwelling catheter specific words but we try to not run to a catheterization because of infections I was like if they're not avoiding on their own because of this neurological issue by the emergency you know this stuff hyper calcimia right because it's released from the bones and there's an issue that takes place with the parathyroid hormones I just want you to know that hypercalcemia is a medical one of the oncological medical emergencies and this is defined as serum calcium greater than 10.5 all right serum calcium better than 10.5 signs and symptoms that didn't go away from Med surge 1 all your signs and symptoms associated with hypercalcemia hyperreflexia decreased level responsiveness polyuria polydipsia cardiac changes that can take place treatment hydration dialysis if needed there's antineoplastic or Cancer drugs that can be anti um Cancer drugs that can be given and drugs to lower the serum calcium do you know one common drug that's used to lower serum calcium it's easy tone the calcium down that's how I used to remember it told me calcium nursing management pretty much um the same with any patient who has hypercalcemia increased fluid intake encourages why laxatives in stool or I have the answer right there but I wanted to ask you a question but it's right there on the PowerPoint um and promote Mobility on the station here's the other one where's my Marshall I want you to think about this disorder here's yourself and the cell has all these little stuff going on in it right including potassium it's one of the key major things lysis destruction of that salt right so if you're thinking destruction of the cell and this potassium was within the cell yeah it's a troublemaker Dr Graham said it's a troublemaker this of course we know it's a medical emergency right yes it's a troublemaker there's cardiac implications that go with it this can cause the patient to go into what oh wait sorry I'm sorry I'm sorry I'm thinking Concordia cardiac arrested right CB FIB Cardiac Arrest with these patients remember that I remember that so um with this does hyperkalemia um calcium hyperkalemia hyper uricemia which is excess uric acid in the blood hyperphosphatemia and Regulatory obviously there you go there you go and look at the other one calcium oh it's attached at the top she didn't forget the electrolyte section do not forget that I keep that picture in your mind so cells break down all of the what's inside spills out right spills out uric acid deposits in the joint yeah so signs and symptoms we already know Cardiac Arrest as a result of that potassium spilling out nausea vomiting arrhythmia bradycardia can take place seizures are late of course Cardiac Arrest is late in the game and acute renal failure also can take place so medical emergency that we need to manage how is the diagnose electrolytes EKG renal studies foreign [Music] hydrate dialysis diuretic think of all those abnormalities that take place with the electrolyte and the appropriate treatment for those electrolyte abnormalities you don't have to think too hard everything exposing to each other nursing management all of those things we discussed this is what you're going to manage as a nurse right cardiac renal side effects of treatment any questions on that component so make sure you know tumor license syndrome Central being a school um Central Venus um thank you after I've been talking from 8 30 this morning spinal cord compression and then superior vena cava syndrome right now how many questions did I tell you that we're going to be on the hematology foreign you said five to eight for Hematology Oncology some of those questions are going to have to do with big hematology stuff that you should know so you know how long over thrombocytopenia neutropenia you should have to study too hard to let you know that stuff right I just want to break down didn't I open it already not everybody I'm falling asleep on me yet we're almost there I promise study oh I'll show you what that is cute and the case study I like because it gives you an introduction to what to get used to when it comes to the exam I'll open that later on today you'll have a week to do it once it's open the case study it's open open it's not tight it's an exam soft right it's not timed you can work on it as a group I don't care as long as you understand the content right so it's on our own it's on your own oh okay yeah you'll have a probing check it already but I want you to get accustomed to working on NGA install questions and then we'll go over it together in class the other thing that I suggest is even though you only have two things that are going to be due towards the end of the semester for Kaplan I highly suggest three for the software practice and play with the other questions on there the other exams that's on there but I'll break down because I need to break down a whole study plan so with the um we're gonna do a whole set of hematology this semester but I thought it was easier if we took the oncology hematology stuff and do it on with oncology and got rid of that part and then we can do the rest of hematology later so again this is basic terminology making sure that you know what the term hematopoe systems right the production and all of these different types of cells and it begins in the bone marrow what happens when it comes to blood cancers There's A disruption in the cell the proliferates uncontrollably makes you know the difference between um the different types of cells but leukemia what's involved is your granulocytes lymphocytes erythrocytes megakaryocytes is that going to be an exam question no I'm going to go over managing the patient with these different types of disorders lymphoma lymph tissue right think lymph tissue and then multiple myeloma it involves the lymphocytes so with leukemia it's broken down into forms all acute and Pacific leukemia AML acute myeloid leukemia all right the key thing is with all all can also all can also occur in adults though it's one common type that you see in children but it can also occur in adults with AML is the most common type of acute leukemia in adults but it occurs in both but most common in adults is that an exam question no but some key thing that you should know I know I know because I see the head concentrating and typing typing it in then you have CLL which is a common chronic adult leukemia and then you have CML that also mainly affects adults so which type of leukemia mainly affects primarily children though you might see other leukemias in children is your Alm oh which of the following is a type of leukemia for you all of the above AML CML a-l-l-c-l-o all of the above all right very simple so AML there's a defect in your stem cells so when you're thinking about it there's a defect in your modern size your granulocytes what's happening with this patient our retrocytes platelets what are we thinking if all of these different cells are immune system what else patient is at risk for what else bleeding because platelets are involved erythrocytes we're looking at oxygenation status right because all of these blood cells are involved most common cause of death for all leukemias manifestation it's easy those which cells are being infected right so they're gonna have fever infection uh weakness fatigue bleeding all of those things that cover the different cells that are being involved that are involved in here so what's the treatment aggressive chemotherapy and you already know the proper management of any patient on chemotherapy because now chemotherapy is a suppressive agent right risk for infection basic hand hygiene these patients can have stem cell transplant done complication believe me everything flows into one another there's not much guesswork um that takes place with the blood cancer CML this is also something else that's a chronic issue of course if it's chronic they're living a little bit longer right they're living a little bit longer treatment keep patient and chronic pain for as long as possible right so we're just treating that patient chemotherapy um hormone hormonal therapy that can also be done for these patients radiation if they qualified radiation therapy and then there's all again prognosis is good for children 85 for three year event um free survival but drops with increased age manifestation we're talking about the lymph system so enlarged liver spleen it can also affect the bone the central nervous system headache and bomb vomiting may be found um incidental what's the treatment you're going to notice the treatment is pretty much the same for a lot of these different blood cancer chemotherapy hsct therapy monoclonal does anybody know what monoclonal when was monoclonal antibody therapy used wait so you do you want us to know the difference between all these I still have to go over it yeah and steroids can be done also you have your chronic your CLL right treatment early stage wash and weight and we're treating with the same set of drugs it depends on that it's individualized it cares individualized I don't want that word to pop up yet can you see it yeah foreign thing in here so you could go over the signs and symptoms of leukemia what are the common signs and symptoms so that's listed within there okay so now you the nurse you're caring for this patient with this blood cancer so what is your responsibility you're going to do your history and physical on this patient you're going to assess for the signs and symptoms that they currently have depending on the signs and symptoms and the complication you're going to treat accordingly okay so again look at the question here's the scenario what's wrong with the patient now once again there's this whole storyline go to that final portion what does this question actually asking you is it actually asking me about leukemia or is it asking me about specific complication associated with it right what am I prioritizing is there an airway issue involved an infectious process involved read that part of the question properly supports with these patients you're going to manage them activity intolerance electrolyte balance self-care spiritual distress all of the things that we discussed with cancer in general these are the same things that you're going to take place this is very repetitive you'll notice right infection bleeding we're gonna do DIC when we do hematology that's an interesting disorder right there right we'll talk about that renal what are we Afraid over to my license Syndrome again yeah so you see this is one obvious problem of your blood cancers your tumor license you know that you can answer a lot of the questions your goal all of the stuff that we spoke about regarding cancer in general your goals for management for the patient is the same with the blood cancer category okay don't overthink it nutrition pain comfort repeating itself mucositis right infection bleeding repeating itself nutrition we're going to manage for that patient in order for them to heal right small frequent something simple for you as a nurse your patient can't eat this large meal can they tolerate small frequent you know meals maybe a little bit of pudding and something else that's not going to hurt their mouth nothing Centric for that patient because that can also cause pain nothing spicy for that patient those basic little things when it comes to nutrition is important easing pain this all repeats itself I'm not going to read through it I'm just going to skip through to the main thing that I need you to know is there going to be a question on Milo dysplastic syndrome don't read about it right so with this it's a disorder of the myeloid stem cell maybe in asymptomatic or the patient could be um fatigued or feel ill only cure is htst or stem cell treatment polycythemia vera noun here's the thing with this disorder I want to make sure that you know that's a question so with polycythemia vera it's a proliferative disorder of the stem cell right I want to see the key thing that I need you to focus on with this one and I wouldn't pay attention to this when you look at some of these symptoms associated with polycythemia vera what would you prioritize as your issue investors elevated pressure and then you can look at the neural symptoms now remember how we said about expected issues versus adverse effects or events and there's a reason why I'm emphasizing this with polycythemia there's this red appearance due to the accumulation of erythrocytes it's expected so the reason why I'm emphasizing this it's it's expected would you think that to be a medical emergency yeah all right just making sure just making sure right so with these patients they have elevated hemoglobin and automatic um because of this mutation that takes place as a result of that now because they have all of these additional blood cells think about it they have the accumulation of all of these additional blood cells that can potentially block off a blood vessel to a vital organ system right so if it's blocking off a blood vessel too a vital um vessel in the brain this can lead to signs and symptoms of throat if it's in cardiac vessels that's blocked these are signs and symptoms that you'll see of heart attack right or cardiac event so here's the weird thing with this disorder though they can clot and they can bleed that makes sense right that makes sense they can have complication because of thrombosis accumulation of the cell all because of the dysfunction of their platelets they can end up bleeding which one you should see it's not um emergency that's the right column yeah if the space is just red it's not leading there's a reason why if the face is red that's expected it's not a medical emergency it's just a sign associated with the disorder so here's the problem with this order you know it can cause clots or block off vital um blood flow to organ systems so our goal is to reduce that right how do we help reduce thrombosis what do we end up giving yeah anticoagulants anti-flating drugs right but here's the problem there you go that's the big issue with this disorder we're trying to prevent this but they already have one potential issue a potential issue with the platelet where they can end up bleeding so it's one of those you know let's treat this but make sure this doesn't happen so because they have accumulation of all of these cells they can have what's called a therapeutic phlebotomy meaning they go in and they have some of their blood removed there's a similarity that's why I want to cover it later so you don't get confused with it there's a similarity simulator I can't even talk anymore sometimes so aggressive management of aposclerosis right because it's blockage of those blood vessels all you puranol to prevent gout right as I say accumulation of one type of acids right low dose aspirin platelet aggregation Inhibitors like Plavix is one of those drugs and there's also a drug called interferon which is one of those um immunosuppressant type drugs that can help the patients I'm not going to ask you any questions on essential thrombocytopenia just know what's thrombocytopenia is in general that's basic is this an option on the exam that I'm going to test you on primary myelofibrosis we never tested on it but here's one of the things that I want you to know for yourself not fantastic remember we're learning not just to test right we're learning in general as nurses that it can lead to you already know what acetite opinion can potentially um cause I'm not going to ask you that last part is the key thing I want to concentrate on so those four leukemias the signs and symptoms associated with leukemius keep that in mind in the nursing management the other last thing really from this component that I want you to focus on is your lymphoma there's two major lymphomas that I want you to focus on Hodgkin lymphoma and non-hodgkin right that's all in the category of lymphoma Hodgkin non-hodgkin here's the big difference Hodgkin I curate Hodgkin's High curate there could be a familial pattern to it they have painless lymph node enlargement cervical um lymphoma enlargement fever sweats weight loss the treatment depends on what stage of that Hodgkin's lymphoma that they're in right so it could be chemo you already know what we managed chemo right radiation and you already know what to monitor for your patients on radiation therapy security non-hodgkin lymph tissues become infiltrated with malignant cells and it's the spread is unpredictable right the spread is unpredictable that I want you to know the risk increases with age this is also painless swelling of the lymph system um and so a word that's missing in there I just want you to keep in mind the key symptom is you'll see painless swelling of the lymph system you see something here what's the complication Hodgkins High curate we have multiple different treatments just information of the nursing management of those treatments Non-Hodgkins unpredictable spread major complication of Non-Hodgkins tumor lysis syndrome and from tumor lysine syndrome you should know everything that comes along with that multiple myeloma um I actually don't have a question on multiple myeloma but you should know a little bit about it and that's how we're going to end today right malignant disease of the B lymphocytes increases with age exposure to radiation so here goes your patient with lung cancer and they had radiation therapy now they're not feeling well right they come back get reassessed by The Physician they're diagnosed with multiple myeloma they had radiation which is one of the risk factors that can lead to them and a lot of times that's what you see patients who have previous types of cancers they receive treatment for that cancer and they end up with this blood cancer so complication infection neural complication and clots and the treatment is pretty much the same with the exception that there's a stolen analog and I don't need you to memorize that any question on this component your four types of AML AML CML CLL your Hodgkins and non-consciousness okay your oncological emergencies [Music] is that everything yeah about five questions right you said five to eight you're over there what I'll do is