Exam 2 - Buerger's, Raynaud's, and Leukemia

Question 1

Nursing education for Buerger’s disease

Answer 1

Autoimmune disease that affects men ages 20-40

Those who smoke are at biggest risk so teach to stop smoking

Question 2

Pt education with Raynaud’s phenomenon

Answer 2

Wear gloves
Triggered by cold and stress
Don’t smoke

Question 3

Medications for Raynaud’s phenomenon

Answer 3

Calcium channel blockers
Alpha blockers
Prescription skin creams
Less often - ACE inhibitors

Question 4

Most common in young children, peak age for diagnosis is 4yo

Answer 4

Acute lymphoblastic leukemia

Question 5

More common in older adults, peak age for diagnosis is 72yo

Answer 5

Chronic lymphocytic leukemia

Question 6

Slow insidious onset, may not have any s/sx but have c/o fatigue, exercise intolerance, swollen lymph glands, enlarge spleen, edema, paleness, thrombophlebitis. Can also develop B symptoms - night sweats, fever, weight loss

Answer 6

Chrornic lymphocytic leukemia

Question 7

Common in older adults
Associated with exposure to toxins, genetic disorders, and treatment of other cancers
S/sx - fatigue, weakness, fever, anemia, headache, bone and joint pain, recurrent infections, bruising, liver/spleen inflammation

Answer 7

Acute myeloid leukemia

Question 8

Associated with Philadelphia chromosome (genetic)

Survival rate in “blast” phase is just months

Answer 8

Chronic myeloid leukemia

Question 9

First phase of chemotherapy treatment

Answer 9

Induction - high doses to kill leukemic cells

Question 10

Second phase of chemotherapy treatment

Answer 10

Consolidation - less strong doses to kill leukemic cells that are left behind

Question 11

What is the main thing you should know about bone marrow transplants?

Answer 11

Must have a donor
Prior to transplant, person receiving has to do aggressive chemo and radiation
Pt is at high risk for infection, bleeding, and anemia so will be in hospital for 6-8 weeks in reverse isolation

Question 12

Biggest issue in bone marrow transplants

Answer 12

Graft vs. host disease

Question 13

What happens with graft vs. host disease?

Answer 13

When bone marrow is eradicated, person is very immunocmopromised and sometimes the transplant tissue mounts a reaction to the person’s body (it rejects the persons body). Can happen immediately or up to 100 days later

Question 14

S/sx of graft vs. host disease

Answer 14

Rash on hands, soles of feet, may cover entire body
Break down of epithelial cells
Inside of GI tract starts to break down (including mouth)

Question 15

What can be given to pt with graft vs. host?

Answer 15

Steroids to fight inflammation, immunosuppressant drugs to dampen response

Question 16

What is a chemotherapy complication?

Answer 16

Tumor lysis syndrome - chemo destroys cells, K and Ph leak out so pt will have high K, low Ca, and high uric acid

Question 17

Nursing considerations for pt who has had chemo or received a bone marrow transplant?

Answer 17

No flowers, no fresh plants
Give good oral care
Pay attention to c/o undue fatigue because first sign of infection could be a crash
No aspirin or OTC meds (NSAIDs, alka-seltzer) because interferes with platelet function
Don’t go into crowded, public places
Avoid fresh fruits and veggies
Report fever, chills, bleeding, bruising, painful urination, foul smelling discharge, skin lesions
Use electric razors
Do not insert anything that can cause damage to tissue or bleeding - suppositories, tampons, enemas
Provide teaching about treatments, support groups, and meds

Question 18

How do you figure ANC?

Answer 18

(% neutrophils + % bands) x total WBC count
______________________________________
100

Question 19

When are neutropenic precautions initiated?

Answer 19

ANC less than 1500 mm^3 = private room