Blood/Cancer Flashcards
What is anemia? What are the 3 general causes for anemia? What vitamins and minerals can affect RBC production?
Lower-than normalhemoglobin/hematocrit levels and fewer-than-normal circulating erythrocytes
Hypo-proliferative: Defective RBC production, bone marrow suppression from disease or chemotherapy
Hemolytic: RBC destruction in the circulation such as sickle cell disease
Bleeding/blood loss: GI blood loss, hemorrhage from trauma, heavy menstruation
iron, folate, Vit. B12 and protein
What are the manifestations of anemia? What are the characteristics of the tongue with megaloblastic anemia? And with iron deficiency anemia?
Fatigue and weakness
Dizziness or syncope upon standing/exertion
Paresthesia (Vit. B12 deficiency)
Pallor
Tachycardia
Dyspnea on exertion
Hypotension (if bleeding)
Jaundice if from hemolysis
Sensitivity to cold
Brittle, ridged, concave (spoon-shaped) nails
Angular cheilosis of lips
Pica
Tongue changes
Beefy red, sore = megaloblastic anemia
Smooth, red = iron deficiency anemia
What does the RBC carry? What is the function of hemoglobin? What does the hematocrit indicate?
RBC carries hemoglobin molecules
Hemoglobin (Hgb)
Transports O₂ to all tissues
Index of oxygen-carrying capacity of blood
Hematocrit (Hct)
Percentage of RBCs in relation to total blood volume
What is the mean corpuscular volume (MCV)? Why is it important? When does normocytic RBCs present? When does microcytic RBCs present? Macrocytic?
size of RBC
helps determine cause of anemia
(normal size) renal disease and anemias cause by chronic disease
(small) iron deficiency
(large) B12 deficiency, folic acid deficiency and alcoholism
What is mean corpuscular hemoglobin (MCH)? How is it quantified?
amount of hemoglobin per RBC
normochromic: normal amount
hypochromic: decreased amount
How is iron-related anemia diagnosed? What does a sickle cell test evaluate? When is a bone marrow aspiration indicated? In what location is it commonly performed?
Total iron-binding capacity (TIBC): Indirect measure of transferrin
Ferritin: Indicates total iron stores in the body
Low levels indicates iron deficiency anemia
Elevated levels may indicate hemochromatosis
Most accurate test to evaluate iron stores in body
Evaluates sickling of RBCs
Used to diagnose any bone marrow diseases such as aplastic anemia, leukemia
posterior pelvic bone (iliac crest)
What is the most common type of anemia that occurs? What are 7 causes?
iron deficiency
inadequate intake of dietary iron
blood loss (GI bleed most common)
menorrhagia
pregnancy
ETOH abuse
IBD
NSAID and aspirin use
When taking supplemental iron enterally, what 2 things can aid in absorption? What are dietary sources of iron?
increase intake of Vit C
Do not take with food. Food decreases absorption
meat
seafood
beans
green leafy veggies
dried fruits (raisins, prunes, apricots, etc)
What is aplastic anemia? What cell lines are affected? Result? S/S? How is it treated?
rare anemia caused by damage to bone marrow stem cells
all three: RBC, WBC, platelet
pancytopenia: anemia, leukopenia, and thrombocytopenia
may not be noticeable at first
infections
fatigue
purpura or petechiae
retinal hemorrhages
splenomegaly
hematopoietic stem cel transplant
immunosuppressive therapy
supportive therapies such as transfusions
what is vitB12 deficiency related to? S/S? B12 causes what 2 dysfunctions? Other than inadequate intake, what can cause B12 deficiency?
absence of intrinsic factor causing pernicious anemia
smooth, sore, red tongue
extreme pallor
paresthesia
loss of balance and proprioception
confusion
anemia and neurological symptoms
atrophic gastritis
gastrectomy
disease of the distal ilium such as Crohn’s
How is megaloblastic anemia managed?
If folate deficiency: increase folate to 1 mg/day
If B12: supplement or months IM or SQ injection, lifelong supplementation
What is a hemolytic anemia? What is its nature? When do RBCs typically sickle? What disfunction does sickled RBCs cause?
sickle cell disease
autosomal recessive
affects African descent
events of illness or hypoxemia
occlusive/ischemia
hemolysis (breakdown of abnormal RBCs in capillaries and spleen)
severe pain d/t ischemia in various sites or organs
what is acute chest syndrome related to sickle cell crisis? Management?
emergency caused by ischemia in the lungs and heart
O2
hydration
opioids
possible antibiotics is bacterial infection present
What are clinical manifestations of sickle cell disease/vaso-occlusive crisis? What can happen with the spleen and gallbladder d/t sickle cell?
Sickled cells hemolyze rapidly and have a shortened lifespan
Anemia is usually present
Hgb values 5 -11 g/dL
Tachycardia
Cardiomegaly and heart failure
Arrhythmias
Jaundice
All tissues and organs can be affected by thrombosis in the microcirculation
Tissue hypoxia
Tissue damage
Tissue necrosis
gallstones from excessive bilirubin from RBC breakdown
splenomegaly from overwork removing RBCs
What is the medical management of sickle cell disease?
aggressive O2, pain control and hydration
hematopoietic stem cell transplant
hydroxyurea: chemo drug increases fetal hemoglobin and decreases the formation of sickled cells
transfusions
What are typical pain control methods for sickle cell?
aspirin
NSAIDs
opioids
What is polycythemia vera? What does the hematocrit indicate? S/S? Risk? Treatment?
blood cancer that causes bone marrow to make too many red blood cells.
Hct may be > 60%, resulting ina thickened blood
Increased blood viscosity (high RBCs)
Ruddycomplexion
Splenomegaly
Hypertension
Pruritis (high bilirubin)
Erythromelalgia (burning in hands/feet;reddish or bluish skin)
At risk for thrombosis complications and bleeding complications
phlebotomy to reduce RBC count
increase fluid
aspirin
myelosuppressive agents
interferon therapy
managment of symptoms such as pruritis
How are cancers of the blood classified? What are the 3 classifications f hematopoietic cancers?
Classified by the specific blood cells involved
Leukemia: Neoplastic proliferation of a certain type of WBC line
Granulocytes (acute myelogenous leukemia, chronic myelogenous leukemia)
Lymphocytes (acute lymphocytic leukemia,chronic lymphocytic leukemia)
Lymphoma: Neoplasms of the lymphoid tissue (Hodgkin and non-Hodgkin)
Multiple myeloma: Malignancy of the plasma cells (B-cell line)
What is leukemia? What does the overgrowth then influence? What then occurs? What is the risk? How is leukemia classified? Which is more aggressive? How is it further differentiated?
Hematopoietic malignancy with unregulated proliferation of leukocytes
Overgrowth prevents growth of other blood components (RBCs and platelets)
Anemia and thrombocytopenia
Lack of mature leukocytes leads to immunosuppression
Infection is the leading cause of death
Divided into acute and chronic leukemia.
Acute leukemia is more aggressive
Further classified by the type of WBC
Lymphoid/lymphocytic (ALL, CLL)
Myeloid (AML, CML)
What is the nature of chronic myeloid leukemia? Goal of treatment?
Mutation in myeloid stem cell
Unregulated proliferation of myeloid white blood cells
Least common type of leukemia
Goal of treatment is to control the disease with chemotherapy:
Obtaining remission or keeping the client in the chronic phase as long as possible, can often live for many years since chronic
CML is not considered curable in older adults but very treatable with chemotherapy
What is the nature of acute lymphocytic leukemia? Who is at risk, what age? Goal of treatment?
Uncontrolled proliferation of immature cells (lymphoblasts) from lymphoid stem cell
B-lymphocyte affected in 75% of cases
75% - 80% of cases found in children
Most common childhood leukemia
Boys affected more than girls
Peak incidence is 4 years of age
Respond very well to chemotherapy
Prognosis is very good for children
What are menifectationso f acute lymphocytic leukemia in children? What do the leukemic cells commonly infiltrate causing what kind of symptoms? What will lab levels reflect?
bleeding gums, bruising
fatigue
Often found incidentally with routine lab studies or physical exam
other organs
CNS often affected
Cranial nerve palsies
Headaches
Vomiting
Hepatomegaly
Splenomegaly
Bone pain
Elevated WBC cells (lymphocytes),low RBCs and platelets
What is the treatment for acute lymphocytic leukemia in children?
chemo
HSCT
tyrosine kinase inhibitor
Who is at risk for chronic lymphotcytic leukemia? Who is it less common in? S/S? Clinical manifestations?
older individuals
family disposition
exposure to agent orange
indigenous people
asian descent
bone pain
bleeding
fever
night sweats
weight loss
May be asymptomatic and diagnosed incidentally
Lymphocytosis is always present
Lymphadenopathy
Splenomegaly
B symptoms (fever, weight loss, night sweats)
Impaired T-cell function causing life-threatening infection and
Increased susceptibility to second malignancies
What are potential complications for all types of leukemia?
serious infection
bleeding
renal dysfunction
infertility
tumor lysis syndrome from treatment
nutritional depletion
fluid and electrolyte imbalances
fatigue
mucositis
depression, anxiety, grief
What is nursing management for leukemia?
Preventing and managing infection and bleeding
Managing mucositis
Improving nutritional intake
Easing pain and discomfort
Maintaining fluid and electrolyte balance
Improving self-care
Managing anxiety and grief
Providing education
What is lymphoma? Where does it affect? What are the 2 major types and their characteristics?
Neoplasms of cells of lymphoid origin
Usually starts in the lymph nodes but can involve lymphoid tissue in the spleen, GI tract, liver, or bone marrow
Two major types:
Hodgkin lymphoma
Younger age, highly treatable
Usually presents with swollen cervical lymph nodes
Weight loss and sweats
Non-Hodgkin lymphoma
Middle to old age disease
Swollen lymph nodes throughout body
Higher mortality rate than Hodgkin disease
What is the nature of hodgkin lymphoma? Age groups affected? Risk factors?
Relatively uncommon
High cure rate
92% - 94% 5-year survival rate for early disease that is localized/regional (stage I or II)
Two peaks of incidence
Ages 15 – 34
After age 60
History of Epstein-Barr virus
Family history of lymphoma
Down syndrome (leukemias and lymphomas)
Chronic immunosuppression
What is the pathophysiology of Hodgkin lymphoma? What are the malignant cells and what do they indicate? Clinical manifestations? Treatment?
Initiates in a single node
Predictable spread along the lymphatic system
Malignant cell is the Reed-Sternberg cell
Pathologic hallmark of disease
Essential criterion for diagnosis
Painless cervical lymph node enlargement
Mild anemia
Fatigue
Anorexia
Increased susceptibility to infections
Cure is the goal
Chemotherapy
Radiation therapy
HSCT for clients who have not responded to other treatment modalities
What is the nature of Non-Hodgkin lymphoma? Who is at risk? Prognosis?
Group of cancers that originate in lymphoid tissue
85% B-cell lymphocytes
15% T-cell lymphocytes
Unpredictable and erraticspread
More common in men
Incidence increases with age
Average age at diagnosis is 66 years
Prognosis varies with the type of NHL
What are clinical manifestations of non-hodgkin lymphoma? Medical managment?
Highly variable symptoms
Night sweats
weight loss
swollen nodes to multiple areas
chronic fevers
fatigue
Other symptoms depend upon enlarged lymph node size and site of the lymph nodes
Goal of treatment: Usually try for remission,sometimes possible cure
Chemotherapy
Potential for tumor lysis syndrome (increased uric acid)
Radiation therapy
What is the patho of multiple myeloma? What can be affected? What is the persistent symptom? What two symptoms should be investigated in older adults to rule out MM?
Malignant disease of the plasma cells
Plasma cells accumulate in the bone marrow and crowd out healthy blood cells
Malignant plasma cells produce a specific, nonfunctional immunoglobulin (antibody) that is released into the blood
“M protein”
Immunoglobulins clog up the kidneys frequently resulting in renal failure
Hypercalcemia develops from the bone destruction
Persistent bone pain is a common symptom of the disease
back pain
elevated total protein
What is the treatment of multiple mylenoma?
not curable
immunotherapy
chemo
HSCT
biphosphonate
pain mngt
infection control
prevent fractures
What 3 incidents can low platelet counts be related to? Manifestations?
Reduced platelet production in the bone marrow (leukemias,chemotherapy)
Increased platelet destruction (Idiopathic thrombocytopenic purpura (ITP))
Increased platelet consumption (Disseminated intravascular coagulation (DIC))
Bleeding
Petechiae on the skin
Epistaxis
Gingival bleeding
Excessive bleeding from surgery or dental extractions
What is the most common site of uncontrolled bleeding with hemophilia?
joints
What is von Willebrand disease? Manifestations? Management?
Inherited disorder that affects men and women equally
reduced levels of vW factor
Necessary for factor VIII activation
Needed for platelet activation
Clinical manifestations- vary
Bleeding that involves the mucus membranes
Often not noticed for years
Easy bruising and petechiae
Prolonged bleeding from cuts and surgical sites
Heavy menstrual cycles
Nose bleeds
Bleeding with dental extractions
Replacement therapies of IVvWF or Factor VIII
Desmopressin/DDAVP (synthetic ADH): Prevents bleeding associated with surgical or dental procedures and provides a transient increase in vWF levels/activity in the body
What are differences between hemophilia and vonWillebrand?
Bleeding from hemophilia is from lack of a clotting factor in the coagulation cascade, preventing a fibrin clot to form
vWDis a deficiency of a protein called von Willibrand factor, preventing formation of a platelet plug
Hemophilia usually has deep bleeding into joints
vWD has superficial bleeding such as gums, skin, lacerations
What is DIC? Patho? Is it a disease? Causes? Is it an emergency?
disseminated intravascular coagulation
Systemic syndrome characterized by microthrombi and bleeding (excessive clotting and bleeding)
Altered hemostasis mechanism causes massive clotting in microcirculation
As clotting factors are consumed bleeding occurs
Not a disease but a sign of an underlying disorder
Common causes: sepsis, trauma (hemorrhage, burns, crush injuries), shock, cardiopulmonary arrest, cancer, obstetric complications, toxins, and allergic reactions
Mortality rate can be > 80%
What are clinical manifestations of DIC? What does a nurse need to look for? What do lab values show?
progressive decrease in platelet count due to consumption of platelets
and
Extensive thrombosis = Manifestations of thrombosis in the involved organs
subtle bleeding that can develop into obvious hemorrhage
Bleeding from mucous membranes, venipuncture sites, GI and GU tracts
Occult internal bleeding
Lab values reveal decreased platelets,increased INR,decreased fibrinogen,RBC fragments/anemia
What is nursing care for DIC?
Early identification of condition usually by thrombotic or hemorrhagic manifestations
Treat underlying cause of the DIC
Implement bleeding precautions
Correct tissue ischemia
Improve oxygenation
Replace fluids and electrolytes
Maintain blood pressure; administer vasopressors
Replacement of coagulation factors and platelets occasionally done (not always)
Administer heparin
Inhibits formation of microthrombi and permits organ perfusion
Provide emotional support
What are 3 other coagulation disorders of not and their patho?
idiopathic thrombocytopenic purpura: decreased lifespan of platelets, can be treated with corticosteroids or splenectomy
thrombotic thrombocytopenic purpura: blood abnormally clots
heparin induced thrombocytopenia: low platelet from heparin treatment
What are indications for heparin use? Routes? Therapeutic range? Nursing care? Antidote?
Indications: DVT and PE treatment, acute coronary syndrome, thrombosis prophylaxis
Routes SC (prophylaxis) or IV
TherapeuticaPTT60 to 80 seconds
Assess for signs of bleeding
Monitorplateletcount
Antidote is protamine sulfate
What are indications for use of warfarin? Route? Therapeutic range? Nursing care? Antidote?
Indications: DVT, PE, a-fib, mechanical heart valve
Given PO
Therapeutic INR 2-3 (3 to 4.5 for mechanical heart valve)
Monitor for any bleeding
Antidote is Vitamin K
What are 4 therapies for blood disorders and their effects?
Splenectomy
Surgical removal of spleen, immunosuppressed following splenectomy, needs vaccines such as pneumococcal, meningococcal, and Hemophilus influenzae (Hib)
Therapeutic apheresis
Blood components are separated and removed via a centrifuge
Blood is returned to client after cleansing
Therapeutic phlebotomy
Removal of certain amount of blood under controlled conditions
Used for hemochromatosis to reduce ferritin and Hg levels
Blood component therapy
Blood separated into primary components: erythrocytes, platelets, plasma
Components that are transfused depend on the condition being treated
What are 3 types of blood transfusions?
Standard transfusion
Transfusion from a compatible blood donor
Autologous transfusions
Client’s own blood is collected for future transfusions (elective surgery)
Collected up to 6 weeks prior to surgery
Designated and only used for the client
Intraoperative blood salvage
Type of autologous transfusion
Sterile blood lost from a procedure is saved
Blood is washed (saline), filtered, and returned to client via IV infusion
Administered intraoperatively or postoperatively
Reinfusion must occur within 6 hours of collection
What are nursing actions with transfusion reactions?
STOP the transfusion
Remove blood tubing from the IV
Initiate an infusion of 0.9% sodium chloride
Monitor client and vital signs
Notify primary provider and implement prescribed treatments
Return blood bag and administration set to the lab for testing
Obtain any samples needed
Document event and reaction
Continue to monitor client
What are the S/S of the 5 transfusion reactions? Treatment?
febrile: temp, chills, malaise
hold transfusion, acetominophen, fluid, resume slowly
hemolytic: fever, chills, flank pain, N/V, shock, dark urine
Stop, IV fluids
allergic: urticaria, pruritis, hives, rarely anaphylaxis
stop, fluid, antihistamines and corticosteroids, resume slowly
TRALI (transfusion related acute lung injury): dyspnea, hypoxemia, bilateral chest infiltrates, fever, cyanosis, hypotension (can occur within 6hrs of transfusion)
stop, airway support, emergency
TACO (transfusion-associated circulatory overload): dyspnea, edema, JVD, crackles, HTN, anxiety
slow or stop blood, O2, diuretics, morphine
What is a more complete list of acute hemolytic blood reaction symptoms?
Fever
Chills
Low-back pain
Tachycardia
Hypotension
Flushing
Nausea
Chest tightness or pain
Tachypnea/dyspnea
Anxiety/ impending sense of doom
Hemoglobinuria
What blood product has a greater risk of bacteria forming? Why? How can a bacterial reaction be prevented?
platelets
stored at room temp
transfuse within 4 hours
What is a transfusion alternative that stimulates bone marrow production of RBCs? Route and frequency? Indications? Monitor?
Epoetin alfa
Administered SC or IV
Usually given 3 times a week to stimulate bone marrow
Commonly used to treat anemia in clients with acute renal failure
Can dangerously elevate BP due to increased hemoglobin levels
Monitor for an increase in blood pressure
Monitor Hgb and Hct twice per week
Monitor for cardiovascular event if Hgb increases too rapidly (> 1g/dL in 2 weeks)
What is the disease pricess of cancer? What is a tumor? What is mestatasis? what is the difference between malignant and benign?
cell is transformed by genetic mutation of cellular DNA
abnormal collection of cells, not all tumors are cancers (some are benign)
Metastasis: Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body
Malignant cancer cells: cells or processes that are characteristic of cancer, such as metastasis,local and distant tissue destruction,unregulated growth
Benign cancer cells: cells that are not cancerous, don’t metastasize, only grow locally, no local tissue invasion or destruction,don’trequire chemo/radiation therapy, sometimes surgery
What are the 3 malignant processes that makes cells carcinogenic?
cellular proliferation: uncontrolled growth, ability to metastasize, no normal apoptosis
cell characteristics: altered shape, structure or metabolism
metastasis: lymphatic and/or hematogenous spread
What are examples of carcinigenic agents/factors?
Viruses and bacteria: HPV, hepatitis B & C, Epstein-Barr, HIV, Helicobacter pylori
Physical factors: Sunlight, radiation, chronic irritation
Chemical agents: Tobacco, Asbestos, pesticides, alcohol, air pollution
Lifestyle factors: Obesity, insufficient physical activity
Diet high in fat, red meat, processed meat, preservatives, additives, and low in fiber
Hormones
Air pollution
Sexual lifestyles
Race, genetic, and familial factors
What are the 5 different classifications of cancer cells and examples?
Carcinoma: Epithelial tissue (glandular or squamous)
80% - 90% of all cancers
Examples: skin, GI tract lining, lung, breast, prostate
Sarcoma: Connective or supportive tissues
Examples: bone, cartilage, fibrous tissue, muscle tissue
Osteosarcoma or chondrosarcoma for example
Leukemia
Hematopoietic cells in the bone marrow
Examples:
WBCs: AML, CML, ALL OR CLL
RBCs: Polycythemia vera
Lymphoma
Develop from lymphocytes
Myeloma
Plasma cells (initially B-cells)
What are examples of primary cancer prevention? Secondary and examples of screenings? Tertiary?
Immunizations
Healthy diet (limit alcohol, sugar, processed meats)
Avoid tobacco
Maintain healthy body weight
Exercise
Sunscreen
Breast feed infants exclusively for the first 6 months of life
Chemoprevention: use of medications or other substances to disrupt cancer development
Cancer screening to identify precancerous lesion and early-stage cancer
Self-examinations at home
Mammogram annually, starting at age 45
Clinical breast exam every 3 years for ages 20 to 39, annually for 40 and up
Colonoscopy starting at age 45
Fecal occult annually
Prostate screening annually, at age 50 (40-45 for those at higher risk)
Pap test start at age 25, then every 3 to 5 years
Monitoring for and preventing recurrence of the primary cancer
Screening for the development of second malignancies in cancer survivors
