ONCOLOGY NURSING REVIEW: Exam Summary
Cancer Overview
• Cancer is a group of over 100 different diseases with varying causes,
manifestations, treatments, and outcomes.
• It can affect any organ system and occur in all age groups.
• Oncology nursing involves care from prevention to end-of-life across multiple
settings: hospitals, outpatient clinics, homes, etc.
Precision Medicine in Oncology
• Uses genomics, biologic databases (like the Human Genome Project), and tech
tools to:
o Identify individual characteristics.
o Guide personalized prevention and treatment.
• Aims to prevent and cure cancers.
Cancer Health Disparities
• Differences in cancer outcomes due to:
o Socioeconomic status
o Race/ethnicity (e.g., Black individuals have higher mortality; Hispanics have
higher infection-related cancers)
o Geographic location (e.g., higher lung cancer in states with more smoking)
• Linked to complex factors like income, diet, healthcare access, environment,
biology, and education.
Pathophysiology of Cancer
• Begins with genetic mutations (inherited or acquired).
• Cells:
o Evade normal growth control and immune defense.
o Gain ability to invade tissues, enter lymph/blood, and metastasize.
Benign vs. Malignant Tumors (Table 12-1 Summary)
Characteristic Benign Malignant
Cell differentiation Well-differentiated Poorly/undifferentiated
Growth pattern Local expansion Infiltrates & invades tissues
Growth rate Slow Variable, faster if anaplastic
Metastasis None Common via blood/lymph/cavities
General effects Usually localized Systemic effects (e.g., weight loss)
Tissue damage Minimal unless obstructive Often extensive
Mortality risk Rarely fatal Often fatal unless controlled
Carcinogenesis (Cancer Development Stages)
1. Initiation: DNA mutations occur from exposure to carcinogens (e.g., chemicals,
viruses).
2. Promotion: Mutated cells proliferate with exposure to co-carcinogens (reversible
stage).
3. Progression: Cells become malignant, stimulate angiogenesis, invade, and
metastasize.
• Oncogenes ("on switches") and tumor suppressor genes ("off switches") regulate
cell growth.
o Mutations in proto-oncogenes (e.g., KRAS, EGFR) → cancer growth.
Cellular Adaptations vs. Cancer
• Normal adaptations: Atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia.
• Malignant growth: Neoplasia – uncontrolled, unregulated cell division.
Etiology of Cancer
1. Viruses & Bacteria (10-12% of cancers)
Agent Associated Cancer
HPV Cervical, head & neck
HBV Liver
EBV Burkitt lymphoma, nasopharyngeal cancer
H. pylori Stomach
S. enteritidis Colon
C. trachomatis Cervical, ovarian
2. Physical Agents
• Sunlight (UV radiation): Skin cancers
• Radiation, asbestos, tobacco, industrial chemicals, chronic inflammation
Cancer Prevention and Detection: Nursing Role
Nurses are essential in health promotion, education, screening, and early detection
across all healthcare settings.
Three Levels of Cancer Prevention
1. Primary Prevention – Preventing cancer before it occurs
• Goal: Reduce risk through health promotion and risk-reduction strategies.
• Examples:
o Vaccinations:
▪ HPV vaccine → prevents cervical, head, and neck cancers.
▪ HBV vaccine → reduces risk of hepatitis B and liver cancer.
o Lifestyle Modifications:
▪ Healthy diet (low fat, high fiber)
▪ Physical activity
▪ Avoiding tobacco and excess alcohol
▪ Using sunscreen to reduce skin cancer risk
2. Secondary Prevention – Early detection and screening
• Goal: Identify precancerous changes or early-stage cancer in asymptomatic
individuals.
• Methods:
o Cancer screenings (per ACS guidelines):
▪ Mammogram (breast cancer)
▪ Pap smear/HPV test (cervical cancer)
▪ Colonoscopy (colorectal cancer)
▪ Low-dose CT scan (lung cancer for high-risk groups)
▪ PSA testing (prostate cancer)
• Nursing Role:
o Promote community-based screening programs.
o Educate underserved populations and address barriers like:
▪ Access to care
▪ Cultural and socioeconomic factors
• Genetic Risk Evaluation:
o Offered in specialized cancer risk programs.
o Includes screening, education, counseling, and genetic testing for
individuals at high risk.
o Supported by organizations like NCCN and NCI.
3. Tertiary Prevention – (Mentioned previously in nursing practice)
• Focus: Reduce complications, disability, and recurrence in those already
diagnosed.
• Includes:
o Symptom management
o Rehabilitation
o Palliative care
o Psychosocial support
Summary Table
Prevention
Goal Examples
Type
HPV/HBV vaccines, smoking cessation,
Primary Prevent cancer occurrence
healthy lifestyle
Prevention
Goal Examples
Type
Detect cancer early
Secondary Screening tests, genetic counseling
(asymptomatic)
Reduce
Tertiary Cancer treatment, rehab, palliative care
complications/recurrence
Tertiary Prevention in Cancer Care
Definition:
• Tertiary prevention focuses on monitoring survivors, preventing cancer
recurrence, and detecting second malignancies.
Goals:
1. Prevent recurrence of primary cancer.
2. Detect secondary cancers, which may arise due to:
o Chemotherapy (e.g., leukemia, lymphoma)
o Radiation therapy
o Genetic predisposition (inherited syndromes)
o Environmental exposures or lifestyle
Nursing Role:
• Monitor for late effects of cancer treatment.
• Educate patients on follow-up care and lifestyle modification.
• Support survivorship care plans, which include:
o Regular follow-ups
o Screening for second malignancies
o Health promotion (e.g., diet, exercise, avoiding smoking/alcohol)
Diagnosis of Cancer
Purpose of Diagnostic Evaluation:
1. Confirm presence and extent of cancer
2. Determine metastasis
3. Evaluate organ function (both involved & unaffected)
4. Obtain tissue/cell samples for:
o Pathology
o Staging and grading
Diagnostic Components:
• Health history & review of systems
• Physical exam
• Imaging: CT scan, MRI, PET, ultrasound, X-rays
• Lab tests: Blood, urine, tumor markers
• Biopsies: Tissue sampling
• Endoscopic procedures: Bronchoscopy, colonoscopy, etc.
Nursing Responsibilities:
• Explain procedures to reduce anxiety.
• Prepare patient (e.g., fasting, consent).
• Address emotional distress—allow patients and families to express fears.
• Provide emotional support and clarify information given by providers.
• Encourage open communication among patient, family, and healthcare team.
Tumor Staging and Grading
Why It's Important:
• Helps determine treatment approach and prognosis
• Provides baseline for tracking response to therapy
Tumor Staging (Extent of disease) – Based on TNM System:
Component Meaning
T Size and extent of primary Tumor
N Involvement of lymph Nodes
M Presence of Metastasis
Example: T2N1M0 means a medium-sized tumor, 1 lymph node involved, no metastasis.
Tumor Grading (Cell appearance/differentiation):
• Indicates how much tumor cells differ from normal cells (degree of malignancy)
Grade Description
G1 Well-differentiated (low grade)
G2 Moderately differentiated
G3 Poorly differentiated (high grade)
G4 Undifferentiated (very aggressive)
Higher grade = more aggressive cancer
Summary Table for Review
Category Key Points
Tertiary Prevention Prevent recurrence & second malignancies; support survivorship
Diagnosis Imaging, labs, biopsy; assess stage, grade, organ function
Nursing Role Emotional support, patient education, communication facilitation
Staging (TNM) Describes tumor size, lymph nodes, and metastasis
Grading (G1-G4) Indicates cellular differentiation and malignancy level
Cancer Screening Guidelines by Site
Cancer Site Target Population Test/Procedure Recommendation
Breast Women 40–44 Mammogram Optional annual screening
Women 45–54 Mammogram Annual screening
Biennial (or continue annual); if
Women 55+ Mammogram
healthy & life expectancy >10 yrs
Cervix Women 21–29 Pap test Every 3 years
HPV test Only if Pap is abnormal
Pap + HPV (co- Every 5 years (preferred) OR Pap
Women 30–65
test) alone every 3 years
Stop screening if past tests were
Women 66+ — normal; stop after total
hysterectomy
Colorectal Adults 45–75 gFOBT or FIT Annually
Stool DNA (MT-
Every 3 years
sDNA)
Cancer Site Target Population Test/Procedure Recommendation
Flexible
Every 5 years
sigmoidoscopy
Colonoscopy Every 10 years
CT colonography Every 5 years
Age 76–84 — Discuss screening with provider
Age 85+ — No screening recommended
Women at Teach symptoms (e.g., abnormal
Endometrial Education
menopause bleeding) and report signs early
Current/former Annual LDCT; shared decision-
smokers (age 55–74, Low-dose CT making required; NOT a
Lung
≥30 pack-year (LDCT) substitute for smoking
history) cessation
Men 50+ (or 45+ if Informed decision-making with
Prostate African American or DRE & PSA provider; only screen if life
high risk) expectancy ≥10 years
Include exam for thyroid,
Cancer- testicles, ovaries, lymph nodes,
Physical exam &
related Adults 20+ oral cavity, skin + health
counseling
Checkup counseling on tobacco, sun, diet,
etc.
Key Nursing Points for Exam
• Nurses’ Role:
o Provide education on screening importance and schedules.
o Address barriers to access (cost, cultural beliefs).
o Encourage early detection behaviors.
o Facilitate informed decision-making, especially for prostate and lung
cancer.
• Shared Decision Making:
o Crucial in prostate and lung cancer screening due to potential
risks/benefits.
• Special Populations:
o African American men: Start prostate screening at 45.
o Women post-hysterectomy or 66+: May stop cervical screening if no history
of abnormalities.
Diagnostic Tests for Cancer
Common
Test Description Used for
Cancer Sites
Detects biochemical Breast, colon,
substances produced Cancer detection lung, ovarian,
Tumor Marker Identification
by cancer cells in & monitoring testicular,
blood or fluids prostate
Breast, lung,
Detects gene
brain, kidney,
Genetic Tumor Markers mutations; helps in Prognosis,
ovarian,
(Prognostic Indicators) treatment selection therapy planning
leukemia,
and risk prediction
lymphoma
Detects breast
Mammography X-ray of breast tissue Breast cancer
abnormalities
Magnetic fields Brain, pelvic,
MRI (Magnetic Resonance produce detailed Visualizes soft thoracic, breast,
Imaging) cross-sectional tissues/organs abdominal
images cancers
Layered x-rays give Neurologic,
CT Scan (Computed Assesses tumor
cross-sectional view pelvic, skeletal,
Tomography) location/spread
of tissues thoracic,
Common
Test Description Used for
Cancer Sites
abdominal
cancers
Real-time x-ray using
Functional Skeletal, lung, GI
Fluoroscopy contrast to visualize
assessment cancers
body cavities
Sound waves create
Ultrasonography Deep tissue Pelvic, abdominal
images of soft tissue
(Ultrasound) assessment cancers
structures
Direct visualization Direct tumor
Bronchial, GI
Endoscopy using a scope; allows visualization,
tract cancers
for biopsy biopsy
IV/injected
radioisotopes Bone, liver,
Functional
Nuclear Medicine Imaging visualize organ kidney, spleen,
imaging
function/tumor thyroid, brain
spread
Lung, liver, colon,
Tracer-based imaging head & neck,
PET (Positron Emission Staging, response
shows metabolic pancreas,
Tomography) to treatment
activity of cells Hodgkin,
melanoma
Greater detail in
Combines metabolic
PET Fusion (PET + CT) tumor Same as PET
+ structural imaging
localization
Breast,
Radio-labeled
colorectal,
monoclonal Antibody-based
Radioimmunoconjugates ovarian, head &
antibodies target detection
neck, lymphoma,
cancer cells
melanoma
Common
Test Description Used for
Cancer Sites
Contrast + imaging
(CT/MRI/fluoro) to Pre-surgical Liver, brain
Vascular Imaging
assess tumor blood planning cancers
supply
Key Points for Exams
• Tumor Markers are useful for diagnosis and monitoring recurrence, but not
always cancer-specific.
• Genetic testing helps in precision oncology (e.g., BRCA1/2 for breast cancer).
• PET scans show function, CT/MRI show structure.
• Endoscopy allows for direct visualization and biopsy.
• Nurses’ Role: Explain procedures, reduce anxiety, obtain consent, assist during
tests, and provide post-procedure care.
Cancer Diagnostics – Overview
Test/Procedure Purpose/Diagnostic Use Examples of Use
Detect cancer-associated Breast, colon, lung, ovarian,
Tumor Markers
substances testicular, prostate
Detect mutations, predict Breast, lung, leukemia,
Genetic Markers
therapy response lymphoma
Mammography X-ray imaging of the breast Breast cancer
Detailed imaging using Neurologic, pelvic, breast
MRI
magnetic fields cancers
Thoracic, abdominal,
CT Scan Cross-sectional imaging
skeletal cancers
Contrast imaging of tissue
Fluoroscopy GI, skeletal, lung cancers
densities
Test/Procedure Purpose/Diagnostic Use Examples of Use
Ultrasound High-frequency sound imaging Pelvic, abdominal tumors
Direct visual inspection and
Endoscopy GI, bronchial cancers
biopsy
Nuclear Medicine Uses radioisotopes for tissue
Bone, liver, brain, thyroid
Imaging imaging
Hodgkin’s, colon, liver, lung,
PET & PET Fusion Shows metabolic activity
melanoma
Breast, head & neck,
Radioimmunoconjugates Antibodies tagged with isotopes
lymphoma
Vascular Imaging Visualizes tumor blood supply Liver, brain cancers
TNM Cancer Staging System
• T – Primary Tumor
o Tx: Cannot assess
o T0: No evidence of tumor
o Tis: Carcinoma in situ
o T1–T4: Increasing tumor size/invasion
• N – Regional Lymph Nodes
o Nx: Cannot assess
o N0: No lymph involvement
o N1–N3: Increasing lymph node involvement
• M – Distant Metastasis
o Mx: Cannot assess
o M0: No distant spread
o M1: Metastasis present
Cancer Grading
• Grade I: Well-differentiated, resembles tissue of origin
• Grade II–III: Moderately to poorly differentiated
• Grade IV: Undifferentiated, aggressive, poor prognosis
Surgery in Cancer Management
Type Purpose
Diagnostic (biopsy) Confirm diagnosis, assess staging
Excisional Remove entire small tumor + margin
Incisional Sample wedge from larger tumor
Needle (FNA/Core) Sample accessible tissue using a needle
Sentinel Node Biopsy (SLNB) Assess first draining lymph node
Primary Surgery Remove tumor completely or debulk
Salvage Surgery Treat recurrence after prior treatment
Palliative Surgery Relieve symptoms or improve QoL
Reconstructive Surgery Restore function or appearance
Localized Tumor Destruction Techniques (Table 12-5)
Procedure Mechanism Examples
Chemotherapy applied Ovarian cancer
Chemosurgery
directly (intraperitoneal)
Freezing tissue with liquid
Cryoablation Prostate, cervical cancer
nitrogen
Procedure Mechanism Examples
Electrosurgery Electric current destruction Skin cancers
Laser Surgery Energy vaporizes tumor Endobronchial obstruction
Photodynamic Therapy Light-activated cytotoxicity Esophageal, lung cancers
Radiofrequency Ablation Liver tumors, bone
Heat-based destruction
(RFA) metastases
Nursing Management of Radiation Therapy
Nursing Goals
• Anticipate, prevent, and manage radiation-related symptoms.
• Maintain treatment adherence and patient comfort and quality of life.
Risk Factors for Radiation Toxicity
• Advanced age
• Radiation dose
• BMI (varies by cancer type)
o ↓ BMI → More toxicity in cervical cancer
o ↑ BMI → More late toxicity in prostate cancer
Key Assessments
• Skin integrity
• Nutritional status
• Fatigue and general well-being
Managing Fatigue
• Reassure that fatigue is treatment-related (not disease progression).
• Recommend aerobic exercise with good adherence.
Radiation Safety for Internal Implants (Brachytherapy)
Precautions for Healthcare Workers
• Time: Limit exposure time
• Distance: Maintain 6 feet from the source
• Shielding: Use lead shielding when needed
Nursing Interventions
• Private room
• Radiation warning signs
• Dosimeter badges for staff
• No pregnant staff or children visitors
• Visitors: 30 minutes max, 6-foot distance
• Educate patients and families to reduce isolation anxiety
Chemotherapy Overview
Definition
• Use of antineoplastic drugs to destroy cancer cells.
• Targets systemic disease; used alone or with surgery/radiation.
Chemotherapy Goals
• Cure, control, or palliation
Cell Kill & Cell Cycle
Cell Cycle Phase Process
G1 RNA and protein synthesis
S DNA synthesis
G2 Pre-mitosis, mitotic spindle forms
Cell Cycle Phase Process
M (Mitosis) Cell division
• Growth fraction: Ratio of dividing to resting cells
• Repeated cycles are required to destroy nondividing cells when they enter active
division.
Classification of Chemotherapy
Agent Type Target Example
Cell Cycle-Specific S or M phase Docetaxel, vinblastine, etoposide
Cell Cycle-Nonspecific All phases Busulfan, cisplatin, bleomycin
• Combination regimens: Increase efficacy, prevent resistance
• Adjuncts: e.g., Leucovorin → enhances fluorouracil, protects from methotrexate
toxicity
Chemotherapy Administration & Safety
Dosing Based On
• Body surface area
• Organ function
• Previous treatments
Dosage Modifications
• Required for toxicity, critical lab values
• Maximum lifetime dose: e.g., doxorubicin → 550 mg/m² (risk of cardiomyopathy)
Extravasation
• Definition: Leakage of IV drug into tissue
• Irritants: Mild inflammation (do not cause necrosis)
• Vesicants: Severe damage (may need skin grafting)
Examples of Vesicants:
• Dactinomycin
• Doxorubicin
• Vinblastine, vincristine
• Nitrogen mustard
Prevention:
• No hand/wrist veins
• Use forearm site
• Use PICC or central lines for frequent/prolonged use
• Always have antidotes and management protocols ready
Hypersensitivity Reactions (HSRs)
Signs & Symptoms
• Rash, urticaria, fever
• Hypotension, cardiac instability
• Dyspnea, wheezing, throat tightness, syncope
Onset
• Immediate: 5 min to 6 hrs post-infusion
• Delayed: After infusion ends
Repeated exposures increase HSR risk.
11. Hematopoietic Stem Cell Transplantation (HSCT)
• Indications: Leukemia, lymphoma, myeloma, some solid tumors
• Collection: Mainly via apheresis (peripheral blood), or bone marrow/cord blood
• Types:
o Allogeneic: From donor (related/unrelated)
o Autologous: From patient
o Syngeneic: From identical twin
• Conditioning regimens:
o Myeloablative: High-dose chemo/irradiation
o Nonmyeloablative: "Mini-transplant" – less intense
ONCOLOGY NURSING REVIEW: Exam Summary
1. Cancer Diagnostics & Classification
Diagnostic Procedures
• Biopsy: Gold standard (incisional, excisional, needle)
• Imaging: CT, MRI, PET scan, ultrasound, X-ray
• Lab Tests: Tumor markers (e.g., PSA, CA-125), CBC, liver enzymes
Grading (Histologic Classification)
• Gx: Cannot assess
• G1: Well-differentiated
• G2: Moderately differentiated
• G3: Poorly differentiated
• G4: Undifferentiated (worst prognosis)
Staging (TNM System)
• T (Tumor size): T0–T4
• N (Lymph node involvement): N0–N3
• M (Metastasis): M0 (none) or M1 (present)
2. Cancer Treatment Modalities
Surgical Interventions
• Primary surgery: Remove entire tumor
• Debulking: Reduce tumor size before adjuvant therapy
• Palliative surgery: Symptom relief
• Reconstructive surgery: Restore function/appearance
Chemotherapy
• Systemic: Affects both cancer and healthy cells
• Goals: Cure, control, or palliate
Radiation Therapy
• External (teletherapy) vs Internal (brachytherapy)
• Aimed at local tumor control
Other Local Treatments
• Cryoablation: Freezing tumor
• Radiofrequency ablation (RFA): Heat via high-frequency energy
3. Nursing Management of Chemotherapy Patients
Pre-, During, and Post-Assessment
• Monitor hematologic, renal, hepatic, pulmonary, cardiovascular, neurologic
functions
• Regular labs and physical assessments
• Survivorship care for long-term effects
Common Complications
• Bone marrow suppression (↓WBC, ↓RBC, ↓platelets)
• Nausea & vomiting (CINV)
• Mucositis, diarrhea, anorexia
• Fatigue and cognitive changes ("chemo brain")
• Risk of extravasation and hypersensitivity reactions (HSRs)
4. Chemotherapy: Safety & Special Concerns
Protecting Nurses & Caregivers
• Wear PPE
• Avoid inhalation/contact
• Handle and dispose of cytotoxic waste carefully
• Use spill kits as needed
Extravasation Signs
• No blood return
• Swelling, burning, redness
• Resistance to IV flow
Action: STOP infusion, use extravasation protocol
Neurotoxicity
• Assess for tremors, numbness, weakness
• Refer to neuro/rehab services
5. Management of Chemo Side Effects
Symptom Nursing Action
CINV Anti-emetics, patient education
Cognitive issues Recommend rest, exercise, cognitive activities
Fatigue Address nutrition, rest, psychosocial support
Anorexia/Nutritional
Small frequent meals, nutrition consult
Deficit
Infection Risk Neutropenic precautions, hygiene education
Symptom Nursing Action
Soft toothbrush, avoid invasive procedures, monitor
Bleeding Risk
platelets
6. Hematopoietic Stem Cell Transplantation (HSCT)
Types of HSCT
• Allogeneic: From donor (related/unrelated)
• Autologous: From patient
• Syngeneic: From identical twin
Conditioning Regimens
• Myeloablative: High-dose chemo ± total body irradiation
• Nonmyeloablative: Lower dose (“mini-transplant”)
Sources of Stem Cells
• Bone marrow
• Peripheral blood (via apheresis – most common)
• Umbilical cord blood
7. Long-Term Effects of Chemotherapy (Chart 12-4 Summary)
• Cardiac: CHF, MI, CAD
• Pulmonary: Pneumonitis
• Endocrine: Hypothyroidism
• Reproductive: Infertility, ↓libido
• Skeletal: Osteoporosis, avascular necrosis
• Neurologic: Neuropathy, tremors
• Immune: Chronic suppression, infections (herpes, sepsis)
• Cancers: Risk for secondary leukemias, lymphomas, solid tumors
SICKLE CELL DISEASE (SCD) – Nursing Notes
Assessment and Diagnostic Findings
• Sickle Cell Trait:
o Normal hemoglobin, hematocrit, and blood smear.
• Sickle Cell Disease (SCD):
o ↓ Hematocrit
o Presence of sickled cells in peripheral smear
o ↑ WBC and platelet count (due to chronic inflammation)
o Definitive diagnosis: Hemoglobin electrophoresis shows HbS
Medical Management
General Overview
• Diagnosed in childhood
• Anemia starts in infancy; crises may begin at 1–2 years old
• Life expectancy: Rarely exceeds 60 years
• Leading causes of death: Cardiac, pulmonary, renal, neurologic complications, and
infection
Goals:
• Control symptoms
• Prevent complications
• Improve quality of life
Hematopoietic Stem Cell Transplant (HSCT)
• Only curative treatment
• Limited to:
o Patients with matched donors
o Those without severe organ damage (renal, hepatic, pulmonary)
Pharmacologic Therapy
Hydroxyurea
• FDA-approved for SCD
• Increases fetal hemoglobin (HbF) → ↓ sickling
• ↓ Frequency of:
o Pain crises
o Acute chest syndrome
o Transfusion need
• Mortality benefit: ↓ 40%
• Side effects:
o Myelosuppression (↓ WBC)
o Teratogenicity
o Potential malignancy risk
• Patient considerations:
o Varies in response
o Adherence challenges
Folic Acid Supplementation
• Daily intake to support ↑ RBC production due to hemolysis
Antibiotic Therapy
• Prompt treatment of infections
• Pediatric risk: Pneumococcal pneumonia
• Adult risk: Staph aureus (bones, joints)
Vaccinations
• Pneumococcal
• Annual influenza
Acute Chest Syndrome (ACS) Management
• Prompt antibiotics
• Incentive spirometry
• Severe cases: Bronchoscopy
• Supportive care:
o Cautious hydration (prevent overload)
o Corticosteroids
o Transfusions
• Monitor for pulmonary hypertension
Transfusion Therapy
Indications:
• Severe anemia (e.g., aplastic crisis)
• Acute vaso-occlusive crisis
• Pre-operative
• Infection-induced anemia
• Acute chest syndrome
• Stroke (cerebral edema)
• Pregnancy complications
Goals:
• Maintain HbS < 30%
Risks:
• Venous access issues → Need for vascular devices
• Infections: Hepatitis, etc.
• Iron overload:
o Organ deposition (liver, heart, pancreas, kidney, pituitary)
o Requires iron chelation therapy
• Increased blood viscosity
o May worsen crisis if HbS not sufficiently reduced
o Solution: Exchange transfusion
Alloimmunization:
• Antibody development → Crossmatching difficult
• ↑ Risk for:
o Avascular necrosis
o Organ failure
o Hemolytic transfusion reaction
Hemolytic Reaction:
• Mimics SCD crisis
• Clue: Patient becomes more anemic post-transfusion
• Management:
o Stop transfusions temporarily
o Support with:
▪ IVIG
▪ Corticosteroids (e.g., prednisone)
▪ Erythropoietin alfa
Supportive Therapy
Pain Management
• Acute pain (vaso-occlusive crisis): Common cause of ER visits
• Neuropathic pain:
o Causes: Nerve damage, avascular necrosis, leg ulcers
Pain Medications:
• Mild: Aspirin
• Moderate: NSAIDs (± opioids)
o Risk: GI bleeding, renal damage, ceiling effect
• Severe: IV opioids (PCA use common)
• Neuropathic:
o Gabapentinoids
o Tricyclic antidepressants
o SNRIs
Chronic Pain Goals:
• Maximize function vs. eliminate pain
• Requires patient education
Non-Pharmacologic Approaches:
• Heat therapy
• Physical/Occupational therapy
• Massage/exercise
• CBT (relaxation, distraction)
• Support groups
Hydration
• Oral: 2–3 L/day if able
• IV: If oral intake is insufficient
Fatigue Management
• Causes:
o Hypoxia from sickled RBCs
o Endothelial inflammation
o ↑ Inflammatory cytokines
o ↓ Muscle strength, exercise tolerance
o ↑ Resting energy use
o Sleep disturbances, depression
• Nursing Consideration:
o Acknowledge chronic fatigue as multidimensional
o Support coping and functional adaptation
