NCLEX-RN 이것만이라도 보고 가자! : Hematology & Oncology │ Nurse Haley

🩸 Hematology & Oncology by Nurse Haley

안녕하세요! 오늘의 간호사 Haley 입니다. 이번 포스트는 혈액계 및 종양환자 간호 핵심 포인트를 정리했습니다. Hematology & Oncology part에서 출제율 높은 부분이니까 시험 1-2일전에 무조건 숙지하고 시험 치루시길 바랍니다.

Type	Cause	Key Findings / Nursing Focus
Iron-deficiency	Chronic blood loss, low Fe intake	Pallor, glossitis, fatigue → Iron supplements (with Vitamin C), stool dark
Pernicious (B12 deficiency)	Lack of intrinsic factor, gastric surgery	Paresthesia, ataxia → Lifelong B12 IM injection
Folic acid deficiency	Poor diet, alcoholism, pregnancy	Similar to B12 but no neuro symptoms
Aplastic	Bone marrow failure	Pancytopenia → bleeding & infection precautions
Sickle Cell	Genetic (Hgb S)	Vaso-occlusive crisis → Hydration, O₂, Pain control, avoid cold/stress

💡 Exam Tip: Sickle cell crisis 시 수액 → 산소 → 진통제 순서! Iron PO는 공복+Vitamin C와 함께, 우유·항생제 피하기.

Reaction Type	Findings	Immediate Nursing Action
Acute Hemolytic	Fever, flank pain, hypotension, red urine	• Stop transfusion • Keep line open NS • Notify HCP/blood bank • Send urine & tubing
Febrile Non-hemolytic	Fever, chills	• Stop → Antipyretics • Leukoreduced product next time
Allergic (mild)	Itching, hives	• Stop temporarily, give antihistamine
TRALI (Lung injury)	Dyspnea, hypoxemia, pulmonary infiltrates	• Stop, O₂, call HCP

⚠️ NCLEX 핵심: Transfusion 시작 후 15분 내 가장 주의! 2인 교차확인 필수, 4시간 내 투여 완료.

Pathophysiology	Labs	Nursing Care
Massive clotting → consumption of platelets & factors → bleeding	PT/PTT↑, D-dimer↑, Plt↓, Fibrinogen↓	• Treat cause (sepsis, trauma) • Replace blood/platelets • Monitor for bleeding, organ ischemia

💡 Exam Tip: DIC = “clot + bleed” 동시에! Heparin은 초기에만 제한적으로 사용될 수 있음(기관지침 우선).

⚠️ Fever in cancer patient = medical emergency! → Broad ABX within 60 min.

Condition	Key Findings	Nursing Action
Tumor Lysis Syndrome (TLS)	↑K⁺, ↑Phos, ↑Uric acid, ↓Ca²⁺ → arrhythmia, renal failure	• Hydration >3 L/day • Allopurinol, monitor EKG, renal labs
SIADH (small cell lung CA)	Hyponatremia, confusion, seizure	• Fluid restriction, hypertonic saline cautiously, seizure precautions
Spinal Cord Compression	Back pain, weakness, incontinence	• Notify HCP, high-dose steroids, MRI, radiation prep
Superior Vena Cava Syndrome	Facial edema, JVD, dyspnea	• High-Fowler, O₂, corticosteroid, no tight clothing

💡 Exam Tip: Oncology 응급은 대부분 수분공급, 전해질 모니터, 신경·호흡관찰이 핵심입니다.

정리: 오늘의 간호사 Haley

#NCLEX #Hematology #Oncology #Anemia #Transfusion #DIC #Neutropenia #CancerEmergency #TLS #SIADH #SCC #RNexam #간호요약