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MS exam 3 > Chapter 30 > Flashcards

Chapter 30 Flashcards

1
Q

Malignancy in which the mechanism that controls production is affected and the production of these cells are disrupted is known as?

A

Hematopoetic malignancies

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2
Q

____ is a neoplastic proliferation of a particular cell type. The defect originates in the hematopoietic stem cells.

A

Leukemia

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3
Q

____ are neoplasms of lymphoid tissue, usually derived from B lymphocytes.

A

Lymphomas

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4
Q

____ ____ is a malignancy of the most mature form of B lymphocyte–the plasma cell.

A

Multiple myeloma

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5
Q

___ ____ ___ ____ is when some hematologic neoplasms develop, hematopoietic control mechanisms may be in place to continue to produce adequate numbers of normal blood cells which are referred to as ___ neoplasms.
*this is when the control mechanism fails

A

clonal stem cell disorder
indolent

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6
Q

____ ___ are slow growing cancers that often remains localized and carry few symptoms.

A

Indolent neoplasms

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7
Q

Indolent neoplasms have increased numbers of cells produced from a culprit clone all have the SAME ____.

A

genotype

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8
Q

_____ ____ are slow growing hematologic neoplasms that are clones normal cells.
**VERY FEW SYMPTOMS

A

Simplified neoplasms

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9
Q

TRUE OR FALSE.
ALL indolent neoplasms will eventually evolve into a malignancy.

A

FALSE, not all

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10
Q

Do all malignancies arise from an indolent neoplasm?

A

NO
They may evolve directly from changed in the stem cell.

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11
Q

____ refers to an increased level of leukocytes in the circulation which can result in elevation of total leukocytes count.

A

Leukocytosis

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12
Q

What is a proliferation of cells in the liver and spleen that leads to enlargement of organs?

A

extra medullary hematopoiesis

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13
Q

What are leukemia risk factors?

A

exposure to radiation or chemicals, certain genetic disorders, and viral infections

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14
Q

____ refers to stem cells that produce lymphocytes
___refers to stem cells that produce non lymphoid blood cells

A

Lymphoid
Myeloid

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15
Q

Acute leukemia characteristics:
- ___ onset often occurring within a few weeks
- leukocyte development is halted at the ___ phase and thus most leukocytes are _____ cells or blasts
- can progress ____ with death occurring within weeks to months ____ aggressive treatment
- more common in ____ and young adults

A

Abrupt
blast, undifferentiated
rapidly, without
children

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16
Q

Chronic leukemia characteristics:
- symptoms evolve over a period of ___ to ____ and the majority of leukocytes produced are mature
- progresses more ____; the disease trajectory can extend for years
- more common between ages ___ and ____

A

months, years
slowly
25, 60

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17
Q

What is the most common non-lymphocytic leukemia?

A

Acute myeloid leukemia

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18
Q

___ ____ ____ is a defect in stem cells that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets.

A

Acute myeloid leukemia

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19
Q

What are S/S of AML?

A

fever and infection, muscle weakness, fatigue, dyspnea on exertion, pallor, petechiae, ecchymosis, bone pain, enlarged spleen and liver, hyperplasia of gums

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20
Q

___ ___ analysis that shows an excess of immature leukocytes (blast cells) is a hallmark sign of AML.

A

Bone marrow

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21
Q

What are the treatment options for AML?

A

aggressive chemotherapy and/or hematopoietic stem cell transplantation
*GOAL IS COMPLETE REMISSON

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22
Q

What are some complications of AML treatment?

A

significant risk for infection and graft-versus-host disease

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23
Q

What are some complications of AML?

A

bleeding (GI, pulmonary, vaginal, intracranial), DIC, high WBC

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24
Q

True or false.
Bleeding and infection are the major causes of death.

A

True

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25
Q

____ ____ ___ is massive leukemic cell =destruction from chemotherapy resulting in the release of intracellular electrolytes and fluids into the systemic circulation. Increase uric acid levels, potassium, and phosphate

A

Tumor lysis syndrome

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26
Q

AML affects all ages with peak incidence at age ___.

A

67

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27
Q

____ ____ ____ is a mutation in myeloid stem cells with uncontrolled proliferation.

A

Chronic myeloid leukemia

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28
Q

What are the stages of chronic myeloid leukemia?

A

chronic phase, transformational phase, blast crisis

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29
Q

What is the cause of CML?

A

a chromosomal translocation where a section of DNA is shifted from chromosome 22 on the BCR gene to chromosome 9 on ABL gene, they fuse and produce an abnormal protein that causes leukocytes to divide rapidly

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30
Q

True or False.
The BCR-ABL gene AKA the Philadelphia translocation is present in virtually all patients with this disease.

A

TRUE

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31
Q

S/S of CML?

A

SOB, confusion, tender spleen, malaise, anorexia, weight loss
**Infection and bleeding are RARE

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32
Q

What is the treatment of CML?

A

imatinib mesylate (Gleevec) blocks signals in leukemic cells that express BCR-ABL protein, chemotherapy, HSCT

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33
Q

____ ____ ____ is uncontrolled proliferation of immature cells from lymphoid stem cells

A

acute lymphocytic leukemia

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34
Q

What population is acute lymphocytic leukemia most popular among?

A

young children, boys more often than girls

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35
Q

True or False. Acute lymphocytic leukemia is very responsive to treatment.

A

TRUE

36
Q

This CNS is frequently a site for ___ cells; thus, patients may exhibit cranial nerve palsies or headache and vomiting because _____ involvement.

A

leukemic
meningeal

37
Q

What is the treatment plan for a patient with acute lymphocytic leukemia?

A

chemotherapy, HSCT, monoclonal antibody therapy, corticosteroids

38
Q

____. is using different combinations and dosages of the drugs used in induction therapy to improve outcomes in those patients at high risk for relapse.

A

Consolidation

39
Q

___ ___ is an intense combination of chemotherapy with purpose to achieve a rapid, complete remission.
*Life threatening side effects, prolonged hospitalization

A

Induction therapy

40
Q

___ ___ is started after remission is achieved.

A

Consolidation therapy

41
Q

____ ____ is lower doses of the drug that the patient received in consolidation therapy Q3-Q4 weeks for months to years.

A

maintenance therapy

42
Q

What is the goal of maintenance therapy?

A

to maintain remission

43
Q

A hematopoietic stem cell transplant is when ____ to ____ mL of bone marrow is aspirated from donor (stem cell obtainment)

A

500-1000

44
Q

What assessments should the nurse complete in a patient with leukemia?

A

health hx
S/S
labs

45
Q

Potential complications of leukemia?

A

infection
bleeding/DIC
renal dysfunction
tumor lysis syndrome
nutritional depletion
mucositis
depression

46
Q

What are some goals for a patient with leukemia?

A

-absence of complications and pain
-attainment of adequate nutrition
-activity tolerance
-ability to cope
-positive body image
-understanding of the disease

47
Q

What are some interventions related to risk of infection and bleeding in a patient with leukemia?

A

Q4 VS
report fever
monitor WBC count
avoid ppl with known infection

48
Q

What are some interventions related to mucositis in a patient with leukemia?

A

-frequent, gentle oral hygiene
-soft toothbrush or sponge tipped applicators when counts are low
-rinse only with NS
-perineal and rectal care

49
Q

Ways to improve nutritional intake in a patient with leukemia?

A

-oral care before and after meals
-administer analgesics before meals
-appropriate treatment of nausea
-small, frequent feedings
-soft foods that are moderate in temperature
-low-microbial diet
-nutritional supplements

50
Q

Ways to ease pain and discomfort in a patient with leukemia?

A

-Tylenol for fever and myalgias
-cool water sponging
-frequent bedding changes
-gentle massage
-relaxations techniques

51
Q

____ ____ is a group of clonal disorders of the myeloid stem cell that cause dysplasia in one or more types of cell lines

A

Myelodysplastic syndromes (MDS)

52
Q

How will patients with MDS present?

A

asymptomatic or with fatigue or illness

53
Q

In MDS, overtime, the bone marrow fails and the patient has ____.

A

pancytopenia

54
Q

The only way to cure MDS is with a _____.
Otherwise treat with bone marrow stimulating agents, blood products, chelation therapy, or myeloid growth factors.

A

HSCT

55
Q

What are the different types of myeloproliferative neoplasms?

A

Polycythemia vera
Essential thrombocythemia
primary myelofobrosis

56
Q

What is polycythemia vera?

A

bone marrow is hypercellular with increased erythrocytes and blood volume

57
Q

What is essential thrombocythemia?

A

stem cell disorder within bone marrow that causes elevated PLT count

58
Q

What is primary myelofibrosis?

A

chronic marrow fibrosis/scarring, extramedullary hematopoiesis in liver and spleen, leukocytosis, thrombocytosis, anemia

59
Q

What are the S/S of polycythemia vera?

A

ruddy complexion and splenomegaly from increased blood volume and viscosity of blood, elevated BP, generalized pruritis

60
Q

What are the risks of polycythemia vera?

A

thrombosis complications (CVA, MI) and bleeding from dysfunctional platelets

61
Q

What is the treatment of polycythemia vera?

A

-therapeutic phlebotomy
-chemotherapeutic agents to suppress bone marrow function
-aggressive management of atherosclerosis
-allopurinol to prevent gout
-aspirin for pain
-platelet aggregation inhibitors
-interferon-alfa

62
Q

Patient education for a patient with polycythemia vera?

A

REDUCE RISK OF THROMBOTIC COMPLICATIONS
-stop smoking
-lose weight
-control hypertension and diabetes
-reduce risk for DVT
-avoid high-dose aspirin
-avoid iron supplements
-cool baths for pruitis

63
Q

Does essential/primary thrombocytopenia affect men or women more?

A

women

64
Q

What are S/S of essential thrombocytopenia?

A

symptoms usually occur from vascular occlusion
headache, enlarged spleen, and hemorrhage

65
Q

Medical management of essential thrombocytopenia depends on?

A

risk for developing thrombosis or hemorrhage and the presence of symptoms

66
Q

What are S/S of primary myelofibrosis?

A

enlarged spleen, fatigue, pruritus, bone pain, wight loss, infection, bleeding, and cachexia

67
Q

What is the treatment of primary myelofibrosis?

A

**based on reducing the burden of the disease
-blood transfusions
-erythroid stimulating agents
-HSCT in younger people
-splenectomy

68
Q

Where does lymphoma typically originate?

A

lymph nodes but can evolve to lymphoid tissue in spleen, GI tract, Liver, or bone marrow

69
Q

_____ lymphoma starts in a single lymph node and may have a viral etiology; cure rate high, especially in stage 1

A

Hodgkin

70
Q

____ ____ ____ is when malignant cells arise from single clone of lymphocytes. Affects mainly B cells, but could affect T cells.

A

Non-hodgkins lymphoma

71
Q

What does stage 1 lymphoma mean?

A

involvement of single lymph node

72
Q

What does stage II lymphoma mean?

A

2 or more on the same side of diaphragm

73
Q

What does stage III lymphoma mean?

A

above and below diaphragm

74
Q

What does stage 4 lymphoma mean?

A

outside diaphragm, liver, and spleen

75
Q

____ ___ is a relatively rare malignancy that has a high cure rate

A

hodgkin disease

76
Q

What are some risk factors of Hodgkins disease?

A

men > women, first-degree relative, its receiving chronic immunosuppressive therapy, veterans exposed to agent orange

77
Q

Pathophis of Hodgkins disease:
Initiated in a ____ node that is large, hard, non-painful, and then spreads by _____ extension along the ____ system.

A

single
contiguous
lymphatic

78
Q

What is the hallmark sign of Hodgkins disease?

A

Reed-Sternberg cell

79
Q

What is the most common signs of Hodgkins disease?

A

enlargement of one or more lymph nodes on one side of the neck that are painless and firm but NOT hard

80
Q

Patient education for Hodgkins disease?

A
  • encourage to reduce risk factors
  • No tobacco or alcohol usage
  • be careful of environmental carcinogens
  • no excessive sunlight
  • screening for late effects of treatment IS necessary
81
Q

In contrast to Hodgkin lymphoma, the lymphoid tissues involved are largely infiltrated with malignant lymphoid cells from multiple sites in _____ ____ ____

A

Non-hodgkins lymphoma

82
Q

Non-hodgkins lymphoma is the ____ most common type of cancer diagnosed in the US

A

sixth

83
Q

What is the treatment for NHL?

A

determined by type and stage of disease and may include, interferon, chemo, radiation, HSCT

84
Q

___ ___ is a malignant disease of the most mature form of B lymphocyte with destruction of bone

A

Multiple myeloma

85
Q

What is the treatment of multiple myeloma?

A

*NO CURE
auto HSCT, chemo, radiation, corticosteroids
NEW: imunomodulatory drugs, thalidomide analogs, monoclonal antibody

86
Q

What are the clinical manifestations of multiple myeloma?

A

bone pain, osteoporosis, fractures, elevated serum protein, renal failure, anemia, fatigue, weakness, increased serum viscosity

MS exam 3 (3 decks)

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