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NRSG 200: Med Surg 3 > [Exam 1] Chapter 34 - Management of Patients with Hematologic Neoplasms > Flashcards

[Exam 1] Chapter 34 - Management of Patients with Hematologic Neoplasms Flashcards

1
Q

What are indolent neoplasms?

A

Where the increased number of cells produced from a culprit clone all have the same genotype

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2
Q

Leukemia: What is Leukocytosis?

A

Refers to an increased level of leukocytes (WBCs) in circulation. Normaly is only one specific typ eof leukocyte.

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3
Q

Leukemia: What is a significant cause of persistent leukocytosis?

A

Hematologic malignancy (leukemia)

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4
Q

Leukemia: Common feature of leukemias?

A

Unregulated proliferation of leukocytes in the bone marrow. Leaves little room for normal cell production.

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5
Q

Leukemia: What is extramedullary hematopoiesis?

A

Proliferation of cells in liver or spleen, can be caused by leukemia

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6
Q

Leukemia: With acute forms, there can be infiltration of leukemic cells in other organs such as

A

meninges, lymph nodes, gums and skin.

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7
Q

Leukemia: Leukemias can be classified how?

A

Either lymphoid (referring to stem cells that produce lymphocytes)

Or myeloid (stem cells that produce nonlymphoid blood cells)

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8
Q

Leukemia: How quickly do symptoms appear in acute leukemia?

A

Onset abrupt, within weeks.

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9
Q

Leukemia: Leukocyte development in acute leukemia?

A

halted at the blast phase, and thus most luekocytes are undifferentiated cells. Can progress rapidly

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10
Q

Leukemia: What happens in chronic leukemia?

A

Symptoms evolve over a period of months to years. Majority of leukocytes produced mature.

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11
Q

Acute Myeloid Leukemia: What does this result from?

A

Defect in the hematopoietic stem cell that differentiates into all myeloid cells (monocytes, granulocytes (neutrophils, basophils, eosinophils) erythrocytes and platelets.

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12
Q

Acute Myeloid Leukemia: Occurs most often with what age group?

A

Rises with age, with peak incidence at age 67

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13
Q

Acute Myeloid Leukemia, Clinical Manifestation: Signs and symptoms typically result from what

A

insufficient production of normal blood cells

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14
Q

Acute Myeloid Leukemia, Clinical Manifestation: What results from neutropenia, anemia, and thrombocytopenia

A

Neutropenia: Fever/Infection

Anemia: Weakness/Fatigue, Dyspnea, Pallor

Thrombocyto: Petechiae, Ecchymoses, and Bleeding Tendencies

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15
Q

Acute Myeloid Leukemia, Clinical Manifestation: What are the three main signs of this?

A

Neutropenia, Anemia, and Thrombocytopenia

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16
Q

Acute Myeloid Leukemia, Clinical Manifestation: Proliferation of leukemic cells within organs leads to what signs?

A

Pain from an enlarged liver or spleen, hyperplasia of gums, and bone pain from expansion of marrow.

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17
Q

Acute Myeloid Leukemia, Clinical Manifestation: Common sign of this on skin?

A

Petechiae or ecchymoses.

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18
Q

Acute Myeloid Leukemia, Assessment: What does a CBC show?

A

A decrease in both erythrocytes and platelets

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19
Q

Acute Myeloid Leukemia, Assessment: What does a bone marrow analysis show

A

Excess , > 20% , of immature leukocytes, called blast cells. Hallmark diagnossi

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20
Q

Acute Myeloid Leukemia, Assessment: Those with acute promyelocytic leukemia have what kind of symptoms

A

potentially fatal bleeding episodes, because they have underlying coagulopathy.

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21
Q

Acute Myeloid Leukemia, Medical Mx: Overall objective of treatment?

A

To achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow.

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22
Q

Acute Myeloid Leukemia, Medical Mx: Remission is achieved by chemotherapy, called induction therapy which involves what

A

high doses of cytarabine or other medications.

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23
Q

Acute Myeloid Leukemia, Medical Mx: Treatment of APL revolves around what

A

induction therapy using the differentiating agents all-trans retinoic acid, which induces promyelocytic blast cells to differentiate, deterring the blasts from proliferating at an immatuer stage.

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24
Q

Acute Myeloid Leukemia, Medical Mx: In AML, induction therapy has a goal of what?

A

Eradicate the leukemic cells. But normal types of myeloid cells erradicated too causing severe neutropenia, leading to anemia and thrombocytopenia

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25
Q

Acute Myeloid Leukemia, Medical Mx: When the ANC is 0, what signs can the patient be experiencing?

A

Will have infections, bleeding, and severe mucositis that causes pain, diarrhea, and inability to maintain adequate nutrition.

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26
Q

Acute Myeloid Leukemia, Medical Mx: Management of this includes what?

A

Adminisering blood products (packed rbcs) and promptly treating infection. Use granulocytic growth factors to shorten period of significant neutropenia by stimulating the bone marrow to produce l eukocytes more quickly

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27
Q

Acute Myeloid Leukemia, Medical Mx: What is done when patient has recovered from induction therapy?

A

Consolidation therapy is given to eliminate any resiudal leukemia cells that are not clinically detectable adn reduce chance for recurrence.

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28
Q

Acute Myeloid Leukemia, Medical Mx: What is another way to treat this patient?

A

HSCT. Use aggressive chemotherapy with goal of destroying hematopoietic function of the patients bone marrow, then being “rescued” with infusion of the donor stem cells to reinitiate blood cell production

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29
Q

Acute Myeloid Leukemia, Medical Mx: Those who under HSCT have a significant risk for what

A

infection and graft-versus-host disease(where the donors lymphocytes (graft) recognize the patient’s body as forieng and set up reactions ot attack the “foreign” host.)

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30
Q

Acute Myeloid Leukemia, Medical Mx: When would supportive care be recommended?

A

When they have significant comorbidity like poor cardiac , pulmonary, renal, or hepatic function.

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31
Q

Acute Myeloid Leukemia, Complications: Complications of this include ?

A

Bleeding and infection, whcihc an cause death. Bleeding correlates with level and duration of platelet deficiency

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32
Q

Acute Myeloid Leukemia, Complications: What can a low platelet count cause?

A

ecchymoses and petechiae.

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33
Q

Acute Myeloid Leukemia, Complications: Most common bleeding sources include?

A

GI, pulmonary, vaginal, and intracranial.

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34
Q

Acute Myeloid Leukemia, Complications: What level of neutrophils increase the risk of infection?

A

Those < 100 . The longer this goes, the risk of developing fungfal infection increases.

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35
Q

Acute Myeloid Leukemia, Complications: What happens as massive leukemic cell destruction from chemotherapy occurs?

A

Release of intracellular electrolytes and fluids into systemic circulation. We see increase in uric acid, potassium, and phosphate and is known as tumor lysis (cell destruction) syndrome

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36
Q

Acute Myeloid Leukemia, Complications: Increased uric acid and phosphorus levels cause what?

A

Make the patient vulnerable to renal stone formation and renal colic, which can progress to AKI

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37
Q

Acute Myeloid Leukemia, Complications: Hyperkalemia and hypocalcemia lead to what

A

cardiac dysrhythmias, hypotension, neuromuscular effects sucha s muscle cramps, weakness, and spasms

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38
Q

Acute Myeloid Leukemia, Complications: GI problems may result from what

A

infiltration of abnormal leukocytes into the abdominal organs and from the toxicity of chemotherapeutic agents. Anorexia, N/V, Diarrhea common.

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39
Q

Chronic Myeloid Leukemia: This arises from what

A

mutation in the myeloid stem cell. Normal myeloid cells production, but increase in production of forms of blast cells.

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40
Q

Chronic Myeloid Leukemia: What happens because of uncontrolled proliferation of cells?

A

Marrow expands into the cavities of long bones, like femur, and cells are also formed in the liver and spleen., resulting in enlargement of these organs

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41
Q

Chronic Myeloid Leukemia: How does this happen on chemisry level?

A

Chromosomal translocation, where section of DNA is shifted from chromosome 22 to chromosome 9. When fusing, they produce an abnormal protein that causes leukocytes to divide rapidly.

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42
Q

Chronic Myeloid Leukemia: What gene is virutally present witha ll patients wiwth this disease

A

BCR-ABL gene

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43
Q

Chronic Myeloid Leukemia - Clinical Manifestations: If asymptomatic, how can leukocytosis be detected?

A

By a CBC

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44
Q

Chronic Myeloid Leukemia - Clinical Manifestations: Leukocyte count may get how high

A

May exceed 100,000

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45
Q

Chronic Myeloid Leukemia - Clinical Manifestations: PAtients with high leukocyte counts may show what signs

A

SOB or slightly confused because of decreased perfusion to lungs and brain from leukostrasis (excessive volume of leukocytes inhibit blood flow through capillaries)

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46
Q

Chronic Myeloid Leukemia - Clinical Manifestations: With there being excess amounts of leukocytes, what organs may be affeceted

A

there may be an enlarged/tender spleen and liver.

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47
Q

Chronic Myeloid Leukemia - Clinical Manifestations: What insidious symptoms will they have?

A

Malaise, anorexia, and weight loss.

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48
Q

Chronic Myeloid Leukemia - Clinical Manifestations: What are the three stages of this?

A

Chronic, transofmration and accelerated or blast crisis.

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49
Q

Chronic Myeloid Leukemia - Clinical Manifestations: What happens during the chronic phase?

A

Have few symptoms and complications from disease, and infections/bleeding is rare.

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50
Q

Chronic Myeloid Leukemia - Medical Mx: How does the oral formula of tyrosine kinase inhibitor work?

A

Works by blocking signals within the leukemia cells taht express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide

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51
Q

Chronic Myeloid Leukemia - Medical Mx: What kind tyrosine kinase inhibitor therapy do?

A

Induce complete remission at the cellular, and even molecular level.

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52
Q

Chronic Myeloid Leukemia - Medical Mx: What may limit absorption and also cause toxicity?

A

Antacids and grapefruit may limit drug absorption, and large doses of acetaminophen may cause hepatotoxicity.

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53
Q

Chronic Myeloid Leukemia - Medical Mx: This is a disease that can be potentially cured with what

A

HSCT in those healthy patients younger than 65.

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54
Q

Chronic Myeloid Leukemia - Medical Mx: The use of tyrosine kinase therapy has decreased what

A

the need for transplantation in cML

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55
Q

Chronic Myeloid Leukemia - Medical Mx: What can occur during the transofmration phase?

A

Marks process of evolution to the acute form of leukemia. Patient may complain of bone pain and may report fevers.

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56
Q

Chronic Myeloid Leukemia - Medical Mx: What may happen if the spleen enlarges?/

A

Patient may become more anemic and thromocytopenic, and an increased basophil level is detected

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57
Q

Chronic Myeloid Leukemia - Medical Mx: What may ocur in the acute form of CML (blast crisis) treatment may resemble what

A

induction therapy for acute leukemia, using the same meds as for AML or ALL.

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58
Q

Chronic Myeloid Leukemia - Nursing Mx: Advances in treatment have changes the course of this disease to what?

A

From life-threatening and likely fatal to being a chronic disease.

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59
Q

Chronic Myeloid Leukemia - Nursing Mx: Drugs used to treat CML may cause what side effects?

A

Fatigue, asthenia, pruritus, headache, skin rash, and oropharyngeal pain are common side effects.

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60
Q

Chronic Myeloid Leukemia - Nursing Mx: What is used to assess for a major molecular response?

A

Blood testing using specific polymerase chain reaction (PCR) to detect level of BCR-ABL

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61
Q

Chronic Myeloid Leukemia - Nursing Mx: What is the most important way to make sure they are treated?

A

Adherence to therapy is critical for optimal outcomes to be achieved.

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62
Q

Acute Lymphocytic Leukemia: What is this?

A

Results from uncontrolled proliferation of immature cells (lymphoblasts) derived form the lymphoid stem cell. The cell of origin is the precursor to B Lymphocytes in 75% of all cases..

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63
Q

Acute Lymphocytic Leukemia: Most common in which population

A

young children , with boys affected more often than girls, and the peak incidence is 4 years of age. After 15, uncommon until age 50.

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64
Q

Acute Lymphocytic Leukemia: How does this respond to treatment?

A

Is very responsive to treatment, and complete remission are at 85%.

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65
Q

Acute Lymphocytic Leukemia: What causes there to be a diminished survival?

A

Increasing age.

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66
Q

Acute Lymphocytic Leukemia: What cna be done if relapse occurs?

A

Resumption of induction therapy can be achieved for a second remission. HSCT can also be useful

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67
Q

Acute Lymphocytic Leukemia, Clinical Manifestations: What do immature lymphocytes do?

A

Proliferate in the marrow and impede the development of normal myeloid cells. Normal hematopoiesis inhibited, resulting in reduced number of granulocytes, erythrocyes and platelets

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68
Q

Acute Lymphocytic Leukemia, Clinical Manifestations: Leukocyte counts may be low or high, but there is always what proportion

A

high proportion of immature cells.

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69
Q

Acute Lymphocytic Leukemia, Clinical Manifestations: What is most common with this type of leukemia?

A

leukemic cell infiltration into other organs and include pain from an enlarged liver or spleen and bone pain

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70
Q

Acute Lymphocytic Leukemia, Clinical Manifestations: What is frequently a sie for leukemic cells?

A

/CNS, so patients may exhibit cranial nerve palsies or headache and vomiing .

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71
Q

Acute Lymphocytic Leukemia, Medical Mx: Goal of treatment?

A

To obtain remission without excess toxicity and with a rapid hematologic recovery so tha additional therapy can be given if needed.

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72
Q

Acute Lymphocytic Leukemia, Medical Mx: Treamtnet plans are based on what?

A

genetic markers of the disease as well as risk factors of the patient, primarily age.

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73
Q

Acute Lymphocytic Leukemia, Medical Mx: What medication is a critical part of the initial induction therapy?

A

Corticosteorids and vinca alkaloids, because lymphoid blast cells are sensitive to this

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74
Q

Acute Lymphocytic Leukemia, Medical Mx: Once a patient is in remission, what special testing can be done?

A

Immunophenotyping, immunoglobulin gene rearrangement, is done to look for residual leukemia cells. Minimum residual testing is a useful prognostic indicator.

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75
Q

Acute Lymphocytic Leukemia, Medical Mx: Goal of consolidation?

A

To improve outcomes in those patients at high risk for relapse. HSCT may also be considered.

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76
Q

Acute Lymphocytic Leukemia, Medical Mx: Therapeutic goal at the time of releapse is what?

A

Reinitiate treatment to obtain a remission and then move quickly to HSCT. Can improve long-term disease-free survival

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77
Q

Acute Lymphocytic Leukemia, Medical Mx: The use of corticosteroids to treat ALL increases patients riskf for what

A

susceptibility to infection, with viral infections being common.

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78
Q

Acute Lymphocytic Leukemia, Medical Mx: Avascular necrosis can occur with who

A

patients treated with corticosteroid-based chemotherapy.

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79
Q

Chronic Lymphocytic Leukemia: Who doese this affect most

A

Older adults, and most common in western world. Family predisposition exists with this.

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80
Q

Chronic Lymphocytic Leukemia - Patho: Where does this come from

A

Malignant clones of B-Lymphocytes. Here, leukemia cells are fully mature. They can escape apoptosis and accumlate in the marrow.

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81
Q

Chronic Lymphocytic Leukemia - Patho: In early stage, what can lymphocyte count be at?

A

Can exceed 100,000

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82
Q

Chronic Lymphocytic Leukemia - Patho: Where do these accumulate?

A

Within the lymph nodes and spleen. Takes less than 12 months for total number to double.

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83
Q

Chronic Lymphocytic Leukemia - Patho: What must be done to identify the presence of these maligannt clones?

A

Imunophenotping the circulating B cells.

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84
Q

Chronic Lymphocytic Leukemia - Patho: What autoimmune complications can occur?

A

Autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura.

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85
Q

Chronic Lymphocytic Leukemia - Patho: What does the reticuloendothelial system do in the autoimmune process?

A

Destroys the bodys own erythrocytes or platelets.

86
Q

Chronic Lymphocytic Leukemia - Patho: Some patients will experience a transofmration into oaggressive lymphoma, known as Richters transofmration. What is this?

A

REsults in increased lymphadenopathy, splenomegaly, worsening b symtpoms and survival of only a few months

87
Q

Chronic Lymphocytic Leukemia - CMs: Many patients show what symptoms?

A

None, and are diagnosed during regular exam. Increased lymphocyte count always present. Enlarged lymph ndoes common and spleen can also be enlarged.

88
Q

Chronic Lymphocytic Leukemia - CMs: Patients can also develop B symtpoms, which is what?

A

Constellation of symptoms including fevers, drenching sweats, and unintentional weight los. T-Cell function impaired, causing further tumor progression.

89
Q

Chronic Lymphocytic Leukemia - CMs: How do these people handle infections later on in advanced disease?

A

Viral infections can become widely disseminated.

90
Q

Chronic Lymphocytic Leukemia - Medical Management: What approach is done for those with no symptoms at time of diagnosis?

A

Watch and wait aproach used. , but treatment may be initiated sooner in the illness trajectory.

91
Q

Chronic Lymphocytic Leukemia - Medical Management: What parameters are considered when treatment is selected?

A

Clinical stage of disease, disease associated symptoms, and functional status of patients, genetic risk, and extent of prior therapy.

92
Q

Chronic Lymphocytic Leukemia - Medical Management: Functional status takes what into consideration?

A

Incorporates individuals life expenctancy, ability to tolerate agggressive therapy, and ability to perform activites of daily living

93
Q

Chronic Lymphocytic Leukemia - Medical Management: What is usually given as initiall therapy?

A

Immunotherapeutic antibody against CD20, but is ineffective when accompanied by a delevtion of the TP53 gene.

94
Q

Chronic Lymphocytic Leukemia - Medical Management: Major side effect of fludarabine

A

prolonged bone marrow supression, with prolonged periods of neutropenia, ,lymphopenia and thrombocytopenia. which puts them at risk for infections.

95
Q

Chronic Lymphocytic Leukemia - Medical Management: Why is MoAb Alemtuzumab (Campath) often used?

A

USed when patient has poor pronostic markers. Targets the CD52 antigen and effective in clearing the marrow and circulation of these cells without affecting stem cells.

96
Q

Chronic Lymphocytic Leukemia - Medical Management: What should be avoided with these patients?

A

Live vaccines.

97
Q

Chronic Lymphocytic Leukemia - Medical Management: Thoughts sabout transplantation like HSCT?

A

May not be an option due to older age. But can be effective in pateints with P53 deletions.

98
Q

Patients with Acute Leukemia: Collaborative problems/potential complications?

A

Infection
Bleeding / DIC
Renal Dysfunction
Tumor Lysis Syndrome

99
Q

Patients with Acute Leukemia - Improving Nutritional Intake: This is often reduced why?

A

Because of pain and discomfort associated with stomatitis.

100
Q

Patients with Acute Leukemia - Improving Nutritional Intake: What can be done before eating to help increase intake?

A

Encouraging or providing mouth care.

101
Q

Patients with Acute Leukemia - Improving Nutritional Intake: Precaution to take if giving oral anesthetic?

A

Patient must be warned to chew with extreme care.

102
Q

Patients with Acute Leukemia - Improving Nutritional Intake: What may be best tolerated by patients?

A

Small, frequent feedings of food that are soft in texture and moderate in termperature

103
Q

Lymphoma: What is this?

A

Neoplasms of cells of lymphoid origin. Start in lymoh nodes and can involve lymphoid tissue in spleen, GI tract, liver or bone marrow

104
Q

Hodgkin Lymphoma: Cure rate?

A

Rare, has a high cure rate

105
Q

Hodgkin Lymphoma: Common with who?

A

More common with men than with women, and occurs from 15-34 and >60 years. Has a familial pattern.

106
Q

Hodgkin Lymphoma - Patho: Where does this begin in?

A

As single node, and spreads along lymphatic system

107
Q

Hodgkin Lymphoma - Patho: What is the malignant cell that causes this?

A

Reed-Sternberg cell, a gigantic tumor cell that is of immature lymphoid origin. Hallmark sign.

108
Q

Hodgkin Lymphoma - Patho: Remaining tumor Reed-Sternberg cell volume is composed of waht?

A

Benign, reactive inflammatory cells that support the growth of this cell.

109
Q

Hodgkin Lymphoma - Patho: What viruses may be implicated in activating the Reed-Sternberg cell?

A

Fragments of Epstein-Barr, or HIV and herpesvirus 8.

110
Q

Hodgkin Lymphoma - Patho: What type of population is this seen in?

A

Those receiving chronic immunosuppressive therapy (Renal transplant) and veterans exposed to herbicide agent orange.

111
Q

Hodgkin Lymphoma - Patho: What would a favorable prognosis consist of?

A

When lymphocytes predominate with few Reed-Sternberg cells and minimal involvement of the lymph nodes.

112
Q

Hodgkin Lymphoma - CMs: How does this usually first show?

A

With an enlargement of one or more lymph nodes on one side of the neck. Usually cervical, supraclavicular, and mediastinal nodes.

113
Q

Hodgkin Lymphoma - CMs: What is the concern with a mediastinal mass?

A

Can be seen on X-Ray, but if large, can compress the trachea and cause dyspnea.

114
Q

Hodgkin Lymphoma - CMs: What abnormalities may they experience?

A

Pruritus (severe itching on skin) and pain after drinking alcohol.

115
Q

Hodgkin Lymphoma - CMs: What part of the body is vulnerable for invasion from the tumor cells?

A

All organs

116
Q

Hodgkin Lymphoma - CMs: Why do symptoms occur?

A

Result from compression of organs by the tumor, like cough and pulmonary effusion, jaundice (hepatic involvement or bile duct blockage) and abominal pain/bone pain.

117
Q

Hodgkin Lymphoma - CMs: Which type of infecction is common?

A

Herpes Zoster.

118
Q

Hodgkin Lymphoma - CMs: B Symptoms are a prime example of this, what are some of this signs?

A

Fever (without chills), drenching sweats (at night) and unintentional weight loss > 10%

119
Q

Hodgkin Lymphoma - CMs: Most common hematologic finding?

A

Mild anemia.

120
Q

Hodgkin Lymphoma - CMs: Leukocyte count here?

A

May be decreased or elevated.

121
Q

Hodgkin Lymphoma - CMs: Platelet count?

A

Typically normal, unless tumor has invaded boen marrow, suppressing hematopoiesis.

122
Q

Hodgkin Lymphoma - CMs: What can be used to assess disease activity?

A

Erythrocyte sedimentation rate adn serum copper.

123
Q

Hodgkin Lymphoma - Assessment/Diagnostic: Diagnosis is made how?

A

By means of an excisional lymph node biopsy adn frequently, the finding of Reed-Sternberg cells.

124
Q

Hodgkin Lymphoma - Assessment/Diagnostic: Once histologic type established, what is done?

A

Staging. After, evaluation of all palpable lymph node chains.

125
Q

Hodgkin Lymphoma - Assessment/Diagnostic: What diagnostics can be performed?

A

X-Ray / CT scan of chest, abdomen, and pelis.

PET can identify resiual disease.

Bone marrow biopsy routinely performed.

126
Q

Hodgkin Lymphoma - Assessment/Diagnostic: Lab tests for hthis?

A

CBC, platelet count, ESR, and liver/renal function tests.

127
Q

Hodgkin Lymphoma - Medical Management: Cure rates for this with this?

A

If early: 85-90%

If advanced, 65-85%

128
Q

Hodgkin Lymphoma - Medical Management: Treatment determined by what?

A

Stage of the disease, and considerations must be made of potential long-term complications, particularly cardiac disease.

129
Q

Hodgkin Lymphoma - Medical Management: Treatment of limited-stage Hodgkin lymphoma commonly involves what

A

Short couse (2-4 months) of chemotherapy followed by radiation therapy to the specific involved area. Has decreased radiation dosage, and decrease in long-term effects

130
Q

Hodgkin Lymphoma - Medical Management: What is the new standard for more advanced disease?

A

Combination chemotherapy with doxorubicin, bleomycin, vinblastine

131
Q

Hodgkin Lymphoma - Medical Management: How does MoAb brentuximb vedotin work for refractory relapsed Hodgkin lymphoma?

A

Drug targets receptor that expressed on surfacec of activated T and B lymphocytes and on Reed-Sternberg

132
Q

Hodgkin Lymphoma - Medical Management: When is HSCT used?

A

For advanced or refractory disease.

133
Q

Hodgkin Lymphoma - Medical Management: What is the leading cause of death in long-term survivors of Hodgkin lymphoma?

A

SEcond malignancies. Latency period of 5 years after which time the risk progressively increases. Most comon are breast, lung, GI, and skin cancers.

134
Q

Hodgkin Lymphoma - Medical Management: What cardiovascular problems can develop 10 years after diagnosis?

A

Coronary artery disease, dysrhythmias, valvular disease, and cardiomyopathy. CHF, and decreased systolic function.

135
Q

Hodgkin Lymphoma - Medical Management: What endocrine problems may occur?

A

High incidence of anxiety and depression may be reported. Fatigue as well.

136
Q

Hodgkin Lymphoma - Nursing Management: What should the nurses be sure to address with the patients?

A

The potential of development of second malignancy. And should be informed that this is curable.

137
Q

Non-Hodgkin Lymphoma: What are these?

A

Heterogenous group of cancers that originate from neoplastic growths of lymphoid tisue. Cells vary morphologically. Most cases involve malignant B Lymphocytes.

138
Q

Non-Hodgkin Lymphoma: How do the lymphoid tissues vary when compared to Hodgkin lymphoma?

A

Those involved are large infiltrated with malignant cells. Spread of malignany lymphoid cells occurs unpredictably and localized disease uncommon. Multiple lymph nodes may be infiltrated.

139
Q

Non-Hodgkin Lymphoma: Median age for this?

A

66 years.

140
Q

Non-Hodgkin Lymphoma: WHo is getting this?

A

Starting to increase in those with immunodeficiencies or autoimmune disorders, prior tx for cancer, and prior organ transplant.

141
Q

Non-Hodgkin Lymphoma, CMs: Most common signs?

A

Lymphadenopathy, and this can wax-and-wane. Is usually not diagnosed until it progresses to a later stage when symptomatic.

142
Q

Non-Hodgkin Lymphoma, CMs: 1/3 of patients have what signs?

A

B Symptoms (Fever, Night Sweats, and Unintentional Weight Loss).

143
Q

Non-Hodgkin Lymphoma, CMs: What problems do lymphomatous masses cause?

A

Can compromise organ function.

144
Q

Non-Hodgkin Lymphoma, Assessment/Diagnostic: ACtual diagnosis is categorized into what classification system?

A

BAsed on histopathology, immunophenotyping, and cytogenetic analysis.

145
Q

Non-Hodgkin Lymphoma, Assessment/Diagnostic: What characteristics do indolent types tend to have?

A

Small cells that are distributed in a circular or follicular pattern.

146
Q

Non-Hodgkin Lymphoma, Assessment/Diagnostic: Aggressive types have what characteristics?

A

LArge or immature cells distributed through nodes in diffuse patern.

147
Q

Non-Hodgkin Lymphoma, Assessment/Diagnostic: Staging determined how?

A

BAsed on data obtained from CT and PET scans, bone marrow biopsies, and CSF.

148
Q

Non-Hodgkin Lymphoma, Assessment/Diagnostic: What classification systems have been developed for older adult population?

A

International Prognostic Index (IPI) and Follicular Lymphoma (FLIPI)

149
Q

Non-Hodgkin Lymphoma, Medical Mx: Tx based on what

A

classification of disease, stage of disease, prior treatment, and abillity to tolerate therapy

150
Q

Non-Hodgkin Lymphoma, Medical Mx: Tolerance to therapy determined by what

A

renal, hepatic, and cardiac function.

151
Q

Non-Hodgkin Lymphoma, Medical Mx: If non aggressve and localized, what is chosen?

A

Radiation alone may be the treatment.

152
Q

Non-Hodgkin Lymphoma, Medical Mx: What is done for aggressive types?

A

Aggressive combinations of chemotherapeutic agents.

153
Q

Non-Hodgkin Lymphoma, Medical Mx: Which ones are not current curable?

A

Indolent lymphomas, such as follicular lymphoma.

154
Q

Non-Hodgkin Lymphoma, Medical Mx: Watchful waiting is another mx option, which is what

A

where therapy is delayed until symptoms develop.

155
Q

Non-Hodgkin Lymphoma, Medical Mx: Patients with limited stage disease will be treated how?

A

Radiation therapy to affected area.

156
Q

Non-Hodgkin Lymphoma, Medical Mx: HSCT is considered for who

A

Those younger than 60

157
Q

Non-Hodgkin Lymphoma, Nursing Mx: When caring for patients with lymphoma, its important for nurse to know what

A

specific disease type, stage of disease, treatment history and current treatemnt.

158
Q

Non-Hodgkin Lymphoma, Nursing Mx: Most commonly used teatment methods for lymphoma are?

A

Chemotherapy and radiation.

159
Q

Non-Hodgkin Lymphoma, Nursing Mx: Chemothrapy causes what side effects

A

systemic (myelosuppression, nausea, hair loss, risk of infection

160
Q

Non-Hodgkin Lymphoma, Nursing Mx: Radiation cuases what side effects

A

specific side effects to area that is being treated.

161
Q

Non-Hodgkin Lymphoma, Nursing Mx: RIsk of infection high, why?

A

Myelosuppression but also form defective immune response.

162
Q

Non-Hodgkin Lymphoma, Nursing Mx: Second malignancies that these patients may fact include what?

A

Persistent fatigue, depression, anxiety, and pulmonary toxicity.

163
Q

Non-Hodgkin Lymphoma, Nursing Mx: Health behavior reccomendations for cancer survivors includes what?

A

avoiding smoking, maintianing normal body mass, improving nutrition, and engaging in 150 mins of aerobin activity per week.

164
Q

Multiple Myeloma: What is this?

A

Malignant disease of the most mature form of B Lymphocyte, the plasma cell.

165
Q

Multiple Myeloma: Plasma cells important why

A

secrete immunoglobulins, which are proteins necessary for antibody production to fight infection.

166
Q

Multiple Myeloma: Staging based on what four criteria?

A

Serum albumin
Serum lactate dehydrogenase (when elevated, shows poorer prognosis)
Serum beta-2 microglobulim (indrect measure of tumor burden)
Cytogenetic findings

167
Q

Multiple Myeloma - Patho: What do malignant plasma cells do here?

A

Produce an increased amount of a spsecific immunoglobulin that is nonfunctional. Normal ones produced in lower quantities.

168
Q

Multiple Myeloma - Patho: What is the specific immunoglobulin that is secreted known as?

A

Can be detected in blood, and is known as monoclonal protien, or M protein. Is useful marker to monitor extent of disease.

169
Q

Multiple Myeloma - Patho: how is M protein usually monitored?

A

By the serum or urine protein electrophoresis.

170
Q

Multiple Myeloma - Patho: What may be elevated because of M protein?

A

total protein level

171
Q

Multiple Myeloma - Patho: What else do malignant plasma cells secrete?

A

Certain substances to stimulate angiogensis to enhance growth of clsuters of plasma cells.

172
Q

Multiple Myeloma - Patho: Plasmacytomas may occur, which is what?

A

When plasma cells infiltrate other tissues. Can occur in sinuses, spinal cord and soft tissues.

173
Q

Multiple Myeloma - Patho: What is the premalignant stage or myeloma known as

A

monoclonal gammopathy of undetermine significant or MGUS.

174
Q

Multiple Myeloma - Patho: End-organ dysfunction can be seen with this, and uses CRAB. What does this stand for

A

Elecated calcium
Renal insufficiency
Anemia
And/Or Bone lesions

175
Q

Multiple Myeloma - CM: CMs of disease result fro what

A

from malignant cells and also the abnormal protein they produce.

176
Q

Multiple Myeloma - CM: What to know about bones?

A

Bone disease present in 80% of cases.

Bone pain majorily reported.

177
Q

Multiple Myeloma - CM: Classic presenting sign of this?

A

BOne pain, usuall in the back or ribs. Pain increases with movement. WIll report less pain on awakening. .

178
Q

Multiple Myeloma - CM: Why are osteoclasts stimulated?

A

Due to osteoclast activating factor and Interleukin-6 being secreted by plasma cells. Involved with bone breakdown. .

179
Q

Multiple Myeloma - CM: What will be seen on bone imaging due to this disease?

A

Lytic lesions and osteoporosis.

180
Q

Multiple Myeloma - CM: Bone destruction can be severe enough to cause what?

A

Vertebral collapse and fractures, including spinal fractures. WHen it does, height reduced and kyphosis occurs.

181
Q

Multiple Myeloma - CM: What happens to electrolytes if bone destruction extensive?

A

Calcium enters serum, and hypercalcemia occurs.

182
Q

Multiple Myeloma - CM: Signs of hypercalcemia?

A

Excessive thirst, dehydration , constipation, AMS, confusiona dn perhaps coma. Kidney failure may occur too.

183
Q

Multiple Myeloma - CM: An older adult that complains of what should be evaluated for possible myeloma?

A

WHose chief complaint is back pain and who has an electated total protein level

184
Q

Multiple Myeloma - CM: What happens to bone marrow has more and more malignant plasma cells produed

A

Bone marow has less space for erythrocyte production, and anemia may occur. Also caused by decrease erythropoietin production by kidney.

185
Q

Multiple Myeloma - CM: Why is infection a problem here?

A

Due to lack of adequate levels of nromal immunoglobulin, and other alterations of immune sysem.

186
Q

Multiple Myeloma - CM: Therapy predisposes patient for acquiring infection why

A

due to high levels of corticosteroids used in treaing idisease.

187
Q

Multiple Myeloma - CM: What neurologic manifestations can occur?

A

Spinal cord compression, and peripheral nerve compression can occur.

Peripheral neuropathy can occur as well.

188
Q

Multiple Myeloma - CM: PLasma cells can secrete excessive amount of imunoglobulin, and viscosity can increase. Signs of hyperviscosity?

A

Bleeding from nose or mouth, headache, blurred vision, paraesthesias, or heart failure.

189
Q

Multiple Myeloma - CM: Thromboembolic events (blood clots) may occur and risk increased when?

A

When high doses of corticosteroids and immunomodulatory drugs used.

190
Q

Multiple Myeloma - Assessment/Diagnostic: Major criteria for diagnosis here?

A

Elevated monoclonal protein level in serum, urine, or light chain ratio.

191
Q

Multiple Myeloma - Assessment/Diagnostic: What else is used to establish diagnosis?

A

Evidence of end organ damage, using acronym CRAB.

192
Q

Multiple Myeloma - Assessment/Diagnostic: Diagnosis confirmed how

A

Bone marrow biopsy

193
Q

Multiple Myeloma - Medical Management: Cure for this?

A

There is none. HSCT is considered to extend remission. Possible to control illness however

194
Q

Multiple Myeloma - Medical Management: Primary tx for those not using HSCT?

A

Chemotherapy

195
Q

Multiple Myeloma - Medical Mx, Early Tx Option: When do people want to start treatment here?

A

Initiate therapy prior to development of CRAB features, when myeloma is considered smoldering.

196
Q

Multiple Myeloma - Medical Mx, Early Tx Option: What meds form the backbobne of myeloma therapy?

A

Corticosteoids, particularly dexamethasone

197
Q

Multiple Myeloma - Medical Mx, Autologous Stem Cell Transplant: What determines eligibility for this?

A

Patients age, functional status, and comorbidites.

198
Q

Multiple Myeloma - Medical Mx, Autologous Stem Cell Transplant: Initial treatment here focused on hat

A

reducing the amount of tumor burden (decrease the number of myeloma cells and reducing monoclonal protein) without damaging patients stem cells which are used latere.

199
Q

Multiple Myeloma - Medical Mx, Pharm Therapy: What two drugs have been developed to help with this?

A

Immunomodulatory drugs (IMiDs): have broad anti-myeloma effect by inhibiting angiogenesis.

Proteasome Inhibitors: Needed to process and clear excess proteins produced.

200
Q

Multiple Myeloma - Medical Mx, Pharm Therapy: Common side effect for someone using thaliodomide?

A

Fatigue, dizziness, constipation, rash, and peripheral neuropathy. Myelosuppression is not a problem.

201
Q

Multiple Myeloma - Medical Mx, Pharm Therapy: Side effects of Bortezomib (a PRoteasome Inhibitor)

A

TRansient thrombocytopenia, orthostatic hypotension, N/V, Skin Rash, Neuropathy, and Asthenia

202
Q

Multiple Myeloma - Medical Mx, Pharm Therapy: What do corticosteroids do here?

A

Induce apoptosis in myeloma cells and decrease bone pain

203
Q

Multiple Myeloma - Medical Mx, Pharm Therapy: Long term effects of corticosteroids can cause what prolems

A

Infection, VTE, Proximal Muscle Weakness, Osteoporosis, cataract formation, mood, and behavior changes

204
Q

Multiple Myeloma - Mging Complications: What is done when lytic lesions result in compression fractures?

A

Vertebroplastly may be performed.

205
Q

Multiple Myeloma - Mging Complications: What is done when patients have significant signs of hyperviscosity?

A

Plasmapheresis may be used to lower the immunoglobulin level.

206
Q

Multiple Myeloma - Nursing Mx: What may be given for pain?

A

NSAIDS in combination wiht opioid analgesics.

207
Q

Multiple Myeloma - Educate about Self Care: What is the most important thing to educate patient on?

A

Activity restrictions, lifting no more than 10 lbs. ALso will need a brace.

208
Q

Multiple Myeloma - Educate about Self Care: What to know for biphosphonate therapy?

A

Brush teeth daily, diminishes likelihood of developing osteonecrosis of the jaw.

209
Q

Multiple Myeloma - Educate about Self Care: What to know for kidneys?

A

Monitor renal function. Can become severe and dialysis needed. Maintain high urine output

210
Q

Multiple Myeloma - Educate about Self Care: What may be a major side effect seen in 50% of patients?

A

Peripheral neuropathy. Can be disabling and interfere with patients ability to perform normal activites.

211
Q

Multiple Myeloma - Educate about Self Care: What should they do if neuropathy occurs?

A

Report symptoms because cessation or reducing doses may diminish the worsening nerve damage.

NRSG 200: Med Surg 3 (46 decks)

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