Chapter 30 Flashcards
Malignancy in which the mechanism that controls production is affected and the production of these cells are disrupted is known as?
Hematopoetic malignancies
____ is a neoplastic proliferation of a particular cell type. The defect originates in the hematopoietic stem cells.
Leukemia
____ are neoplasms of lymphoid tissue, usually derived from B lymphocytes.
Lymphomas
____ ____ is a malignancy of the most mature form of B lymphocyte–the plasma cell.
Multiple myeloma
___ ____ ___ ____ 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
clonal stem cell disorder
indolent
____ ___ are slow growing cancers that often remains localized and carry few symptoms.
Indolent neoplasms
Indolent neoplasms have increased numbers of cells produced from a culprit clone all have the SAME ____.
genotype
_____ ____ are slow growing hematologic neoplasms that are clones normal cells.
**VERY FEW SYMPTOMS
Simplified neoplasms
TRUE OR FALSE.
ALL indolent neoplasms will eventually evolve into a malignancy.
FALSE, not all
Do all malignancies arise from an indolent neoplasm?
NO
They may evolve directly from changed in the stem cell.
____ refers to an increased level of leukocytes in the circulation which can result in elevation of total leukocytes count.
Leukocytosis
What is a proliferation of cells in the liver and spleen that leads to enlargement of organs?
extra medullary hematopoiesis
What are leukemia risk factors?
exposure to radiation or chemicals, certain genetic disorders, and viral infections
____ refers to stem cells that produce lymphocytes
___refers to stem cells that produce non lymphoid blood cells
Lymphoid
Myeloid
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
Abrupt
blast, undifferentiated
rapidly, without
children
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 ____
months, years
slowly
25, 60
What is the most common non-lymphocytic leukemia?
Acute myeloid leukemia
___ ____ ____ is a defect in stem cells that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets.
Acute myeloid leukemia
What are S/S of AML?
fever and infection, muscle weakness, fatigue, dyspnea on exertion, pallor, petechiae, ecchymosis, bone pain, enlarged spleen and liver, hyperplasia of gums
___ ___ analysis that shows an excess of immature leukocytes (blast cells) is a hallmark sign of AML.
Bone marrow
What are the treatment options for AML?
aggressive chemotherapy and/or hematopoietic stem cell transplantation
*GOAL IS COMPLETE REMISSON
What are some complications of AML treatment?
significant risk for infection and graft-versus-host disease
What are some complications of AML?
bleeding (GI, pulmonary, vaginal, intracranial), DIC, high WBC
True or false.
Bleeding and infection are the major causes of death.
True
____ ____ ___ 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
Tumor lysis syndrome
AML affects all ages with peak incidence at age ___.
67
____ ____ ____ is a mutation in myeloid stem cells with uncontrolled proliferation.
Chronic myeloid leukemia
What are the stages of chronic myeloid leukemia?
chronic phase, transformational phase, blast crisis
What is the cause of CML?
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
True or False.
The BCR-ABL gene AKA the Philadelphia translocation is present in virtually all patients with this disease.
TRUE
S/S of CML?
SOB, confusion, tender spleen, malaise, anorexia, weight loss
**Infection and bleeding are RARE
What is the treatment of CML?
imatinib mesylate (Gleevec) blocks signals in leukemic cells that express BCR-ABL protein, chemotherapy, HSCT
____ ____ ____ is uncontrolled proliferation of immature cells from lymphoid stem cells
acute lymphocytic leukemia
What population is acute lymphocytic leukemia most popular among?
young children, boys more often than girls
True or False. Acute lymphocytic leukemia is very responsive to treatment.
TRUE
This CNS is frequently a site for ___ cells; thus, patients may exhibit cranial nerve palsies or headache and vomiting because _____ involvement.
leukemic
meningeal
What is the treatment plan for a patient with acute lymphocytic leukemia?
chemotherapy, HSCT, monoclonal antibody therapy, corticosteroids
____. is using different combinations and dosages of the drugs used in induction therapy to improve outcomes in those patients at high risk for relapse.
Consolidation
___ ___ is an intense combination of chemotherapy with purpose to achieve a rapid, complete remission.
*Life threatening side effects, prolonged hospitalization
Induction therapy
___ ___ is started after remission is achieved.
Consolidation therapy
____ ____ is lower doses of the drug that the patient received in consolidation therapy Q3-Q4 weeks for months to years.
maintenance therapy
What is the goal of maintenance therapy?
to maintain remission
A hematopoietic stem cell transplant is when ____ to ____ mL of bone marrow is aspirated from donor (stem cell obtainment)
500-1000
What assessments should the nurse complete in a patient with leukemia?
health hx
S/S
labs
Potential complications of leukemia?
infection
bleeding/DIC
renal dysfunction
tumor lysis syndrome
nutritional depletion
mucositis
depression
What are some goals for a patient with leukemia?
-absence of complications and pain
-attainment of adequate nutrition
-activity tolerance
-ability to cope
-positive body image
-understanding of the disease
What are some interventions related to risk of infection and bleeding in a patient with leukemia?
Q4 VS
report fever
monitor WBC count
avoid ppl with known infection
What are some interventions related to mucositis in a patient with leukemia?
-frequent, gentle oral hygiene
-soft toothbrush or sponge tipped applicators when counts are low
-rinse only with NS
-perineal and rectal care
Ways to improve nutritional intake in a patient with leukemia?
-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
Ways to ease pain and discomfort in a patient with leukemia?
-Tylenol for fever and myalgias
-cool water sponging
-frequent bedding changes
-gentle massage
-relaxations techniques
____ ____ is a group of clonal disorders of the myeloid stem cell that cause dysplasia in one or more types of cell lines
Myelodysplastic syndromes (MDS)
How will patients with MDS present?
asymptomatic or with fatigue or illness
In MDS, overtime, the bone marrow fails and the patient has ____.
pancytopenia
The only way to cure MDS is with a _____.
Otherwise treat with bone marrow stimulating agents, blood products, chelation therapy, or myeloid growth factors.
HSCT
What are the different types of myeloproliferative neoplasms?
Polycythemia vera
Essential thrombocythemia
primary myelofobrosis
What is polycythemia vera?
bone marrow is hypercellular with increased erythrocytes and blood volume
What is essential thrombocythemia?
stem cell disorder within bone marrow that causes elevated PLT count
What is primary myelofibrosis?
chronic marrow fibrosis/scarring, extramedullary hematopoiesis in liver and spleen, leukocytosis, thrombocytosis, anemia
What are the S/S of polycythemia vera?
ruddy complexion and splenomegaly from increased blood volume and viscosity of blood, elevated BP, generalized pruritis
What are the risks of polycythemia vera?
thrombosis complications (CVA, MI) and bleeding from dysfunctional platelets
What is the treatment of polycythemia vera?
-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
Patient education for a patient with polycythemia vera?
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
Does essential/primary thrombocytopenia affect men or women more?
women
What are S/S of essential thrombocytopenia?
symptoms usually occur from vascular occlusion
headache, enlarged spleen, and hemorrhage
Medical management of essential thrombocytopenia depends on?
risk for developing thrombosis or hemorrhage and the presence of symptoms
What are S/S of primary myelofibrosis?
enlarged spleen, fatigue, pruritus, bone pain, wight loss, infection, bleeding, and cachexia
What is the treatment of primary myelofibrosis?
**based on reducing the burden of the disease
-blood transfusions
-erythroid stimulating agents
-HSCT in younger people
-splenectomy
Where does lymphoma typically originate?
lymph nodes but can evolve to lymphoid tissue in spleen, GI tract, Liver, or bone marrow
_____ lymphoma starts in a single lymph node and may have a viral etiology; cure rate high, especially in stage 1
Hodgkin
____ ____ ____ is when malignant cells arise from single clone of lymphocytes. Affects mainly B cells, but could affect T cells.
Non-hodgkins lymphoma
What does stage 1 lymphoma mean?
involvement of single lymph node
What does stage II lymphoma mean?
2 or more on the same side of diaphragm
What does stage III lymphoma mean?
above and below diaphragm
What does stage 4 lymphoma mean?
outside diaphragm, liver, and spleen
____ ___ is a relatively rare malignancy that has a high cure rate
hodgkin disease
What are some risk factors of Hodgkins disease?
men > women, first-degree relative, its receiving chronic immunosuppressive therapy, veterans exposed to agent orange
Pathophis of Hodgkins disease:
Initiated in a ____ node that is large, hard, non-painful, and then spreads by _____ extension along the ____ system.
single
contiguous
lymphatic
What is the hallmark sign of Hodgkins disease?
Reed-Sternberg cell
What is the most common signs of Hodgkins disease?
enlargement of one or more lymph nodes on one side of the neck that are painless and firm but NOT hard
Patient education for Hodgkins disease?
- 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
In contrast to Hodgkin lymphoma, the lymphoid tissues involved are largely infiltrated with malignant lymphoid cells from multiple sites in _____ ____ ____
Non-hodgkins lymphoma
Non-hodgkins lymphoma is the ____ most common type of cancer diagnosed in the US
sixth
What is the treatment for NHL?
determined by type and stage of disease and may include, interferon, chemo, radiation, HSCT
___ ___ is a malignant disease of the most mature form of B lymphocyte with destruction of bone
Multiple myeloma
What is the treatment of multiple myeloma?
*NO CURE
auto HSCT, chemo, radiation, corticosteroids
NEW: imunomodulatory drugs, thalidomide analogs, monoclonal antibody
What are the clinical manifestations of multiple myeloma?
bone pain, osteoporosis, fractures, elevated serum protein, renal failure, anemia, fatigue, weakness, increased serum viscosity
