IV FLUID RATE COMPUTATIONS

MACRODRIP = MICRODRP = SOLUSET =

20/15/10 gtt/mL 60/30 gtt/mL 60 gtt/mL

DROP FACTOR (gtt/mL) – is the number of drops of an infusion that add to a volume
equal to 1 mL
FLOW RATE (gtt/min) – the rate at which a volume of fluid flows past a designated point.

FORMULAS

1. DROPS PER MINUTE (gtt/min)

A B C

EXAMPLE:
A B C

2. HOW MANY mL/hr

FORMULA EXAMPLE

3. TO INFUSE HOW MANY HOURS

FORMULA EXAMPLE

4. MINUTES OF INFUSION
FORMULA EXAMPLE

BODY SURFCAE AREA (BSA) = WT (kg) x HT (cm)<30.48ft-cm/2.54inc-cm>/3600 √

1 inch = 2.54 cm
1 foot = 30.4 cm

ABSOLUTE NEUTROPHIL COUNT (ANC) – is the measure of the number of

neutrophil granulocytes present in the blood.
NORMAL ANC = 1,500 ANC = WBC x Neutrophil % x 100

RISK FOR INFECTION

GRADE 1 Slight = < 2,000
GRADE 2 Minimal = < 1,500
GRADE 3 Moderate = < 1,000
GRADE 4 Severe = <500

CARBOPLATIN DOSE COMPUTATION

CREA CLEARANCE

1
CARBOPLATIN AUC DOSING (Calvert Formula)

TABLE OF FLOW RATE (gtt/min) for

INTRAVENOUS FLUIDS
# OF 1000mL 500mL 250mL
HOURS
3 83 42 16
4 63 31 13
5 50 25 10
6 42 21 9
7 36 18 8
8 31 16 7
9 28 14 6
10 25 13 6
11 23 11 5
12 21 10 –
13 19 10 –
14 18 9 –
15 17 8 –
16 16 8 –
17 15 7 –
18 14 7 –
19 13 7 –
20 12-13 3 –
24 10-11 – –
NORMAL VALUES
RBC 4.5-6M LIFESPAN
120 days or
Transfused
RBC
50-60days
WBC 5,000 - 10,000 14 days
NEUTROPHIL 45.00- 65.00% 5-90 hrs
PLATELET 150,000 - 4-6 days
400,000
CREA 0.84-1.21 mg/Dl
45.00- 84.00 umol/L
SGPT/ALT 0.00-33.00 u/L
SGOT/AST 7-56 u/L
iCA 4.62-5.28 mg/dL
Hemoglobin 12.00- 16.00 g/Dl
Hematocrit 38.00- 47.00%
Sodium 136.00- 145.00 mmol/L
Potassium 3.50- 5.10 mmol/L
Chloride 98.00- 107.00 mmol/L

2
ONCOLOGY – is the study and treatment of tumors
CANCER – is a disease resulting from the interaction of multiple factors at the cellular,
genetic, immunologic and environmental levels.
– Basically a disease of uncontrolled cell division.
CELL – from the Latin word “Cella” meaning small room, is the basic structural, functional
and biological unit of all known living organisms.
– The smallest unit of life.
CELL CYCLE – ordered series if events involving cell growth and cell division that
produces new daughter cells.

STAGES OF CELL CYCLE

1. INTERPHASE – During interphase, the cell undergoes normal growth processes while
also preparing for cell division. The three stages of interphase are called G1, S, and G2.

G1 Phase (First Gap) – from a microscopic aspect, little change is visible.

However, during the G1 stage, the cell is quite active at the biochemical level. The cell is
accumulating the building blocks of chromosomal DNA and the associated proteins as well
as accumulating sufficient energy reserves to complete the task of replicating each
chromosome in the nucleus.
S Phase (Synthesis of DNA) – in the S phase, DNA replication can proceed
through the mechanisms that result in the formation of identical pairs of DNA molecules—
sister chromatids—that are firmly attached to the centromeric region. The centrosome is
duplicated during the S phase.
G2 Phase (Second Gap) – In the G2 phase, the cell replenishes its energy stores
and synthesizes proteins necessary for chromosome manipulation.

2. MITOSIC PHASE – The mitotic phase is multistep process during which the
duplicated chromosomes are aligned, separated, and move into two new, identical
daughter cells.

KARYOKINESIS (MITOSIS) – is divided into a series of phases—prophase,

prometaphase, metaphase, anaphase, and telophase—that result in the division of the cell
nucleus.

3
 CYTOKINESIS (CELL MOTION) – is the second main stage of the mitotic phase
during which cell division is completed via the physical separation of the cytoplasmic
components into two daughter cells.

3. G0 PHASE – Cells in G0 phase are not actively preparing to divide. The cell is in a
quiescent (inactive) stage that occurs when cells exit the cell cycle. Some cells enter G0
temporarily until an external signal triggers the onset of G1. Other cells that never or rarely
divide, such as mature cardiac muscle and nerve cells, remain in G0 permanently.

THEORIES AND RESEARCH MODELS OF TUMOR DEVELOPMENT

1. THEORY OF CLONAL EVOLUTION – Hold that cells within a particular tumor

must at some have had the same genetic makeup and been homogenous.
2. CELL CULTURE MODELS – permits investigation of cancer development at the
cellular level.

MUTATION – is an alteration in a DNA nucleotide sequence ie, order of the 4 bases

Adenine, Cytosine, Thymine, Guanine.
ONCOGENES – genes that encode proteins (oncoproteins) whose action may transform
cells and induce cancer.
APOPTOSIS – “programmed cell death” or “cell suicide”, is a gene-directed method of
cell destruction.
METASTASIS – spread of tumor cells usually via the bloodstream or lymphatic system
from the primary tumor site to a distant site in the body.

IMMUNOLOGY

IMMUNE SYSTEM – two overall functions 1) recognize foreign substance 2) eliminate

foreign substance with restoration of homeostasis.
ANTIGENS – foreign organisms that invade the body
INNATE IMMUNITY – body’s first line of defence provides non-specific responses
(Inflammation & Phagocytosis) to foreign substances.
ADAPTIVE OR ACQUIRED IMMUNITY – highly specific for particular antigen.
ANAMESIS – type of immunity that has memory meaning that the response improves
with each successive encounter with the same antigen.

IMMUNE RESPONSE

1. APPROPRIATE – results in elimination of antigen and the restoration of homeostasis

with memory.
2. IMMUNE DEFICIENCY – under activity of the immune processes, characterized by a
pattern of repeated infections with a simple organism.
3. OVERACTIVE OR INAPPROPRIATE
ALLERGY – inappropriate response to innocuous foreign substance.
AUTOIMMUNITY – response to self-tissue antigen.
GRAFT REJECTION – result of transplanted organ.
4
CLASSIFICATION AND NAMING

CARCINOMA – Cancer that begins in the skin or in tissue that cover internal organs.
There are a number subtype of carcinoma including Adenocarcinoma, Basal Cell
Carcinoma, Squamous Cell Carcinoma and Transitional Cell Carcinoma. Tissue commonly
affected: Breast, Colorectal, Lung, Prostate, Skin.
SARCOMA – Cancer that begins in the bone (not marrow), cartilage, fat, muscle, blood
vessels or other connective or supportive tissues.
LEUKEMIA – Cancer that starts in blood forming tissue such as the bone marrow and
causes large numbers of abnormal blood cells to be produces and enter the blood.
LYMPHOMA AND MYELOMA – Cancers that begin in the cells of the immune system.
CENTRAL NERVOUS SYSTEM CANCER – Cancers that begin in the tissue of the
brain and spinal cord.

BENIGN TUMORS MALIGNANT TUMORS

Add “OMA” to the cell of origin Add “CARCINOMA” or “SARCOMA”
Capable of Mitosis to cellular origin
Adheres tightly Have no purpose
Not capable of Metastasis Complete cell cycle
Anaplastic, Adhere loosely
Can spread

PREFIX MEANING
ADENO Gland
CHONDRO Cartilage
ERYTHRO RBC
HEMANGIO Blood Vessels
HEPATO Liver
LIPO Fat
LYMPHO Lymphocyte
MELANO Pigment Cell
MYELO Bone Marrow
MYO Muscle
OSTEO Bone
BENIGN MALIGNANT
FIBROBLAST
Fibroma Fibrosarcoma
GLANDULAR
Adenoma Adenocarcinoma
MELANOCYTE
Nevus Malignant Melanoma
FATTY TISSUE
Lipoma Liposarcoma
MUSCLE
Leiomyoma Leiomyosarcoma

5
DIFFERENTIATION – The process by which the progeny of stem cells develop into
mature cells and during this process the cells gain specialized functions, structures and
biochemical properties.

ANAPLASIA – is a change in the structure and orientation of cells, characterized by a loss

of differentiation and reversion to a more primitive form.

FEATURES OF ANAPLASIA
LOSS OF POLARITY – malignant cells may not develop connections with one another
producing a jumbled appearance.
LOSS OF SPECIALIZED FUNCITONS – malignant cells may not develop specialized
functions (eg, keratin production, mucous production)
PLEOMORPHISM – malignant cells vary in size and shape, their nuclei may also vary in
size and shape.
ALTERED NUCLEAR/CYTOPLASMIC RATIO – the nuclei of malignant cells are
often large compared to their cytoplasm.
HYPERCHROMATISM – the cytoplasm and nuclei of malignant cells often stain darker
than normal cells.
ENLARGED/MULTIPLE NUCLEOLI – the nucleoli of malignant cells often are increased
in size &number
ABNORMAL MITOSES – a feature recognized by “abnormal mitotic figures”
TUMOR GIANT CELL –occasionally, individual malignant cells become large enough to be
called giant cell

LOCAL INVASION – malignant cells have the ability to break through the basement
membrane and invade surrounding tissues.
IN SITU – local, staying still
BASEMENT MEMBRANE – anchors the epithelium to the organ and provides a
barrier
EPITHELIUM – encloses the organ and protects and secretes fluid to aid protection
LOCALIZED TUMOR – spreads, pushes through the basement membrane and
goes into the organ.

METASTASIS – the process by which malignant cells travel from the primary tumor to a
secondary site.

6
METASTASES – neoplasms which are discontinuous with the primary tumor (the actual
neoplasm)

PROCESS OF METASTASIS
1. Detachment from Primary Tumor
2. Migration/Invation
3. Intravasation (cells enter into blood vessels)
4. Arrest and Extrabsation (cells leave blood vessels and go into the surrounding
tissue)
5. Proliferation/Growth of metastatic mass

ROUTES OF METASTASIS
1. DIRECT SEEDING – is the spread of cancer across a cavity, does not go through the
lymph.
Eg. Ovarian cancer spreading into the peritoneal cavity or Colon cancer spreading into the
peritoneal cavity
2. LYMPHATIC SYSTEM – Blood is pumped through the circulatory system
– Pressure increases as the blood vessels get smaller (arteries, arterioles, capillaries)
– The liquid portion of the blood (plasma) is forced outside of the arteriole side of the
capillary bed into the surrounding tissue
– The liquid which bathes the surrounding tissue is called INTERSTITIAL FLUID
– The plasma lost to a tissue is drawn into the vessels on the venule side of the capillary
bed which is at a lower pressure. Therefore, the tissues are being bathed with fluid which is
constantly changing.
– The amount of fluid lost on the arteriole side is greater than what is drawn in on the
venule side. If this is not remedied somehow the result is EDEMA
– Lymphatic vessels are on the venule side of the capillary bed. These vessels take up the
remainder of the interstitial fluid (thus no edema). This fluid, LYMPH, is transported away
from the capillary bed via the lymphatic vessels. These vessels converge in certain areas of
the body to form regional lymph nodes.
– Lymph nodes filter and trap unwanted material that has been taken up in the
interstitial fluid. WBC’s in the nodes engulf antigens and stimulate immune response if
necessary.
– Cancer cells travel via lymphatic system and get trapped in the regional lymph nodes
(Neck, Groin, Axilla). The presence of one or more cancer cells in a lymph node is an
indication of possible metastasis.
3. CIRCULATORY SYSTEM – Occurs when tumor cells enter the blood vessels at the
primary tumor site. Also occurs when tumor cells have been shed into the blood from the
thoracic duct or right lymphatic duct. Tumor cells become trapped in the next capillary
network.

GRADING AND STAGING – will give an individual classification of a neoplasm

GRADE – The degree to which cells appear abnormal; under pathological microscopic
examination. The aspect of the cell which are considered:
– Size of the cell, Shape of the cell, Extent of cellular differentiation, Organization
of the cell (Histological grade), Size of the nuclei (Nuclei index), Shape of the
nuclei, Mitotic index of tissue (number of cells undergoing mitosis compared to
ones that are not)
7
 – SCALE OF 1 TO 4 typically. The greater the number the greater the degree of cellular
abnormality
– Assists in the determination of: Malignancy, Growth Potential, Metastatic Potential

TUMOR GRADE – is the description of a tumor based on how abnormal the tumor cells
and the tumor tissue look under a microscope. It is an indicator of how quickly a tumor is
likely to grow and spread. If the cells of the tumor and the organization of the tumor’s
tissue are close to those of normal cells and tissue, the tumor is called WELL-
DIFFERENTIATED. These tumors tend to grow and spread at a slower rate than tumors
that are UNDIFFERENTIATED or POORLY DIFFERENTIATED, which have abnormal-
looking cells and may lack normal tissue structures.

GRADE

GX Grade cannot be assessed (Undetermined Grade)

G1 Well-Differentiated (Low grade)
G2 Moderately differentiated (Intermediate grade)
G3 Poorly differentiated (High grade)
G4 Undifferentiated (High grade)

CANCER TYPE-SPECIFIC GRADING SYSTEMS

Breast and prostate cancers are the most common types of cancer that have their
own grading systems.

NOTTINGHAM GRADING SYSTEM (also called the Elston-Ellis modification of the

Scarff-Bloom-Richardson grading system) for breast cancer. This system grades breast
tumors based on the following features:

Each of the categories gets a score between 1 and 3; a score of “1” means the cells and tumor
tissue look the most like normal cells and tissue, and a score of “3” means the cells and
tissue look the most abnormal. The scores for the three categories are then added, yielding a
total score of 3 to 9. Three grades are possible:

Total score = 3–5: G1 (Low grade or well differentiated)

Total score = 6–7: G2 (Intermediate grade or moderately differentiated)
Total score = 8–9: G3 (High grade or poorly differentiated)

8
THE GLEASON SCORING SYSTEM is used to grade prostate cancer. The Gleason score
is based on biopsy samples taken from the prostate. The pathologist checks the samples to
see how similar the tumor tissue looks to normal prostate tissue.

Tumor grade is not the same as the stage of a cancer. CANCER STAGE refers to the size
and/or extent (reach) of the original (primary) tumor and whether or not cancer cells have
spread in the body. Cancer stage is based on factors such as the Location of the primary
tumor, Tumor size, Regional lymph node involvement (the spread of cancer to nearby
lymph nodes), and The number of tumors present.
Staging helps determines appropriate treatment for the patient, assists in estimating a
patient’s prognosis, may also determine a patient’s eligibility to enter a clinical trial and
provides a common terminology for health care providers and researches that allow for
evaluation and comparison of clinical trials.

CANCER STAGING TNM SYSTEM

– The Site of the primary tumor
– Tumor size and number
– Lymph node involvement (spread of cancer into lymph nodes)
– Cell type and tumor grade (how closely the cancer cells resemble normal tissue
cells)
– The presence of absence of metastasis