NCLEX Review Guide: Adult Health - Hematological & Oncological Surgery

Hematological Assessment

• Complete Blood Count (CBC) must be evaluated for platelet count >50,000/μL and hemoglobin >8 g/dL before surgery to prevent excessive bleeding.
• Coagulation studies (PT/INR, aPTT) should be within normal limits, with INR <1.5 for most surgical procedures.
• Patients with thrombocytopenia may require platelet transfusion if count is <50,000/μL for major surgery.

Tumor Lysis Syndrome Prevention

• High Alert: Monitor for hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia following tumor removal or chemotherapy administration.
• Administer allopurinol prophylactically to prevent uric acid nephropathy and maintain urine output >100 mL/hr.
• Aggressive hydration with normal saline 3L/m²/day helps prevent kidney damage from cellular debris.

1. Establish IV access with large-bore catheter
2. Begin aggressive hydration 24-48 hours pre-operatively
3. Monitor electrolytes every 6-8 hours
4. Administer rasburicase if uric acid levels elevated
5. Prepare for potential dialysis if severe

Bleeding Management

• Hemorrhage is the most common post-operative complication in hematological patients due to coagulopathy and thrombocytopenia.
• Monitor surgical sites every 15 minutes initially, then hourly for signs of active bleeding, hematoma formation, or expanding bruising.
• Maintain strict bed rest and avoid unnecessary venipunctures to minimize bleeding risk.

Neutropenia Precautions

• Implement neutropenic precautions when absolute neutrophil count (ANC) <1,000/μL to prevent life-threatening infections.
• Use strict aseptic technique for all procedures and limit invasive devices to essential only.
• Monitor temperature every 4 hours and report any elevation >100.4°F (38°C) immediately as fever may be the only sign of infection.