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HESI®
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HESI®-RN Comprehensive Review
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Hematology and Oncology

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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid

Hematology and Oncology
38 Picmonics to Learn | 1 hr 13 mins
Iron Deficiency Anemia
Causes
Malnutrition/Malabsorption
Hemorrhage
Signs
Microcytic, Hypochromic Anemia
Decreased Heme Synthesis
Labs
Decreased Reticulocytes
Decreased Ferritin
Increased Red Cell Distribution Width (RDW)
Poikilocytosis
Anisocytosis
Increased Central Pallor
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2 mins
Red Blood Cell Count (RBC) Lab Values
Women: 3.5-5.5 million cells/ MuL
Men: 4.3-5.9 million cells/ MuL
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1 min
Hemoglobin (Hgb) Lab Values
Men: 13 - 17 g/dL
Women: 12 - 16 g/dL
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47 secs
Hematocrit (Hct) Lab Values
Women: 36% - 46%
Men: 41% - 53%
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1 min
Types of Blood Products
Types
Whole Blood
Packed Red Blood Cells
Fresh Frozen Plasma
Immunoglobulins
Clotting Factors
Albumin
Platelets
Considerations
Use within 24 Hours
Washing Removes Antibodies
Irradiation Destroys WBCs
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2 mins
Blood Transfusion Administration
Proper Patient Identification
Large Bore Needle
Y Tubing
Baseline Vital Signs
Slow IV Infusion
Monitor During First 15 Minutes or 50 mL of Blood
Monitor for Reactions
Considerations
Do Not Add Anything To Same IV Line
No Dextrose or Lactated Ringers
Jehovah's Witnesses, No Transfusions
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3 mins
Iron (Ferrous Sulfate)
Mechanism
Ferrous Salts
Indications
Anemia
Side Effects
GI Distress
Nausea and Vomiting
Dark Stools
Considerations
Take Between Meals
Liquid can Stain Teeth
Keep out of Reach from Children
Caution with GI Disorders
Avoid Antacids
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3 mins
Cobalamin (Vitamin B12)
Mechanism
Vitamin B12
Indications
Vitamin Deficiency
Pernicious Anemia
Side Effects
Hypokalemia
Arthralgia
Dizziness
Considerations
IM Injection for Pernicious Anemia
Never Give IV
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2 mins
Sickle Cell Anemia Assessment
Cause/Mechanism
Hemoglobin S (Genetic Defect)
Sickle Shaped RBCs
Assessment
Jaundice
Vaso Occlusive Crisis
Fever
Priapism
Severe Pain
Considerations
Prominent in African Americans
May be Asymptomatic
Increased Risk of Infection
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2 mins
Sickle Cell Anemia Interventions
Interventions
Increase Hydration
Analgesics
Oxygen
Warm Compress
Bone Marrow Transplant
Hydroxyurea
Considerations
Avoid High Altitudes
Prophylactic Antibiotics
Avoid Strenuous Exercise
Vaccines
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3 mins
Leukemia Assessment
Cause
Immature WBCs
Assessment
Recurrent Infections
Easy Bruising
Bleeding
Anemia
Fatigue
Weight Loss
Bone Pain
Considerations
May Have Normal or High WBC Count
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2 mins
Leukemia Interventions
Diagnosis
Bone Marrow Aspiration
X-Rays
Interventions
Chemotherapy
Bleeding Precautions
Neutropenic Precautions
Strict Asepsis
Bone Marrow Transplant
Blood Transfusions
Monitor Temperature Elevations
Adequate Nutrition
Imatinib (Gleevec) for Chronic Myelogenous Leukemia (CML)
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3 mins
Chloramphenicol (Chloromycetin)
Mechanism
Bacteriostatic
Indications
Gram Positive or Gram Negative Infections
Side Effects
Bone Marrow Suppression
Aplastic Crisis
Gray Syndrome
Considerations
Toxicity Limits Use
Monitor Blood Counts
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2 mins
Lumbar Puncture
Indications
CSF Sample
CSF Pressure
Considerations
Empty Bladder
Side-lying Position
Between 3rd and 4th Lumbar Vertebrae
Number Tubes
Supine Position After Procedure
Contraindications
Increased ICP (Intracranial Pressure)
Infection at Puncture Site
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2 mins
Cyclophosphamide
Mechanism
Requires Bioactivation by Liver
Cross-links DNA
Guanine N7 Position
Indications
Autoimmune Disorders
Leukemia
Lymphoma
Solid Tumors
Side Effects
Myelosuppression
Hemorrhagic Cystitis
Prevent with Mesna
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3 mins
Cisplatin (Platinol)
Mechanism
Alkylating Agent
Cross-Links DNA
Indications
Testicular Cancer
Ovarian Cancer
Side Effects
Nausea and Vomiting
Myelosuppression
Nephrotoxicity
Ototoxicity
Peripheral Neuropathy
Considerations
Antiemetics Before Administration
Aggressive Hydration
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3 mins
Busulfan
Indications
CML
Bone Marrow Ablation
Mechanism
Cross-Links DNA
Side Effects
Myelosuppression
Pulmonary Fibrosis
Hyperpigmentation
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55 secs
Methotrexate
Indications
Rheumatoid Arthritis
Cancer
Medical Abortion
Mechanism
Folic Acid Analog
Inhibits Dihydrofolate Reductase
Side Effects
Pulmonary Fibrosis
Myelosuppression is Treated with Leucovorin Rescue (Folinic Acid)
Macrocytic Anemia
Hepatitis
Teratogenic
Mucositis
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2 mins
Bleomycin
Indications
Testicular Cancer
Hodgkin's Lymphoma
Mechanism of Action
Induces Free Radical Formation
Breaks in DNA Strands
Side Effects
Pulmonary Fibrosis
Skin Changes
Mucositis
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1 min
Hydroxyurea
Mechanism
Inhibits Ribonucleotide Reductase
Decreased DNA Synthesis
S-phase Specific
Indications
Melanoma
Chronic Myelogenous Leukemia (CML)
Sickle Cell Disease
Through Increased HbF (Fetal Hemoglobin)
Side Effects
Myelosuppression
GI Distress
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2 mins
Vincristine (Oncovin)
Mechanism
Vinca Alkaloid
Inhibits Microtubules
Indications
Leukemias
Lymphomas
Side Effects
Peripheral Neuropathy
Paralytic Ileus
Considerations
Vesicant
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2 mins
Prednisone (Glucocorticoids)
Mechanism
Glucocorticoid
Indications
Inflammatory Conditions
Organ Transplant Rejection
Side Effects
Cataracts and Glaucoma
Cushing's Syndrome
Osteoporosis
Immunosuppression
Hyperglycemia
Ulcers
Considerations
Adrenal Insufficiency
Taper Gradually
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2 mins
Leuprolide
Mechanism
GnRH Agonist (Pulsatile Use)
GnRH Antagonist (Continuous Use)
Upregulates FSH And LH
Downregulates FSH And LH
Indications Pulsatile
Infertility
Indications Continuous
Prostate Cancer
Precocious Puberty
Uterine Fibroids
Endometriosis
Side Effects
Anti-androgenic Effects
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2 mins
Tamoxifen
Mechanism of Action
Selective Estrogen Receptor Modulator (SERM)
Antagonist on Breast Tissue
Indications
ER-positive Breast Cancer
Side Effects
Decreased Risk of Osteoporosis
Increased Risk of Endometrial Cancer
Increased Risk of Venous Thromboembolism (VTE)
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1 min
Steroid Hormones
Characteristics
Nuclear Membrane
Long-Lived and Slow-Acting
Cholesterol-Derived
Intracellular Receptors
DNA Transcription
Examples
Testosterone
Aldosterone
Estrogen
Cortisol
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2 mins
Rituximab
Indications
Chronic Lymphocytic Leukemia (CLL)
Non-Hodgkin Lymphoma
Rheumatoid Arthritis
Microscopic Polyangiitis (MPA)
Granulomatosis with Polyangiitis (Formerly Wegener's)
Mechanism
Monoclonal Antibody Against CD20
Found on B Cell Neoplasms
Side Effects
Infusion Reactions
Skin and Mouth Reactions
Reactivation of Hepatitis B Virus (HBV)
Progressive Multifocal Leukoencephalopathy (PML)
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3 mins
Erythropoietin
Mechanism
Stimulates RBC Production
Indications
Chronic Renal Failure
Anemia
Side Effects
Increased Risk of Thrombosis
Pelvic and Limb Pain
Hypertension
Considerations
Do Not Shake
Monitor Hemoglobin (Hgb) Weekly
May Accelerate Tumor Progression
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2 mins
Promethazine (Phenergan)
Mechanism
Histamine H1 Receptor Antagonist
Weak Dopamine Antagonist
Indications
Nausea and Vomiting
Motion Sickness
Side Effects
Respiratory Depression
Sedation
Anticholinergic Effects
Extrapyramidal Symptoms
Considerations
Use Large Bore IV
Monitor for Tissue Necrosis
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2 mins
Metoclopramide
Indications
Antiemetic
Promotility Agent
Mechanism
Increased Resting Tone
Antagonist at D2 Receptor
Side Effects
Parkinsonian Symptoms
Galactorrhea
Contraindication
Small Bowel Obstruction
Parkinson's Disease
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2 mins
Haloperidol (Haldol)
Mechanism
High Potency Antipsychotic
Indications
Migraine
Schizophrenia
Side Effects
Extrapyramidal Symptoms
Weight Gain
QT Prolongation
Restlessness
Considerations
Caution in Seizure Patients
Neuroleptic Malignant Syndrome
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2 mins
First Generation Antihistamines
Mechanism of Action
Histamine H1 Receptor Antagonist
Indications
Allergies
Nausea and Vomiting
Motion Sickness
Anaphylaxis
Drug Names
Diphenhydramine (Benadryl)
Promethazine (Phenergan)
Chlorpheniramine
Side Effects
Sedation
Anticholinergic Effects
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2 mins
Ondansetron
Indications
Postoperative Vomiting
Chemotherapy-induced Nausea and Vomiting
Mechanism
5-HT3 Serotonergic Antagonist
Centrally-acting Antiemetic
Side Effects
Headache
Constipation
QT Prolongation
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1 min
Bleeding Precautions
Things to Avoid
Hard Foods
Aspirin Products
Blowing Nose Forcefully
Straining During BMs
Enemas or Rectal Suppositories
Pads and Monitor Menstruation
Guidelines to Follow
Soft-bristled Toothbrush
Electric Razor
Limit Needle Sticks
Smaller Needle Size
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3 mins
Macroscopic Bone Structure
Characteristics
Compact Bone
Yellow Bone Marrow
Spongy Bone
Red Bone Marrow
Long Bone
Epiphysis
Epiphyseal Plate
Diaphysis
Metaphysis
Periosteum
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2 mins
WBC Differential Lab Value
White Blood Cells (WBC)
5-10 (5,000-10,000)
Leukocyte Differential
Neutrophils (50%-70%)
Bands (2%-5%)
Segs (50%-70%)
Lymphocytes (20%-40%)
Monocytes (4%-8%)
Eosinophils (2%-4%)
Basophils (0.5%-1.5%)
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2 mins
Hodgkin's Lymphoma Assessment
Cause
Lymph Node Cancer
Contiguous Spread
Assessment
Painless Lymphadenopathy
Constitutional B Signs
Night Sweats
Fever
Weight Loss
Considerations
Bimodal Age Distribution
Reed-Sternberg Cells
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2 mins
Hodgkin's Lymphoma Interventions
Diagnosis
Biopsy
Staging
Interventions
Radiation
Chemotherapy
Treat Side Effects of Therapy
Considerations
Secondary Cancer Screening
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2 mins
Non-Hodgkin's Lymphoma Assessment
Cause
Lymphatic Cancer
Non-Contiguous Spread
B or T Cells
Assessment
Painless Lymphadenopathy
Constitutional B Signs
Night Sweats
Fever
Weight Loss
Mediastinal or Abdominal Mass
Considerations
Older Adults
> 60 Subtypes
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2 mins

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