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NUR 201 Week 3 > Hematological Disorders > Flashcards

Hematological Disorders Flashcards

- Focusing on leukemia and lymphoma.

1
Q

?

Is cancer of the lymph node tissue

A

Lymphoma

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2
Q

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Are usually cancers of the bone marrow

Is an uncontrolled proliferation of malignant lymphocytes that originate in the bone marrow. Is a type of cancer associated with mass production of immature WBCs, or blasts, in the bone marrow

A

Leukemia

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3
Q

Factors Associated with Leukemia

  • Genetics
  • Exposure to ionizing radiation/chemicals
  • Congenital abnormalities
A
  • Acute (sudden onset with short duration) and chronic (slower onset, persistent for years)
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4
Q

Signs & Symptoms

  • Bleeding
  • Petechiae/ecchymosis
  • Fatigue, weakness
  • Fever
  • Flu-like symptoms
  • Enlarged liver/spleen, anorexia, bone pain
A

Diagnostics

  • CBC
  • Bone marrow examination
    > Bone marrow biopsy/aspiration (from sternum or iliac crest)
  • Lumbar puncture (LP) [have cells entered the CNS or spinal fluid?]
  • MRI/CT
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5
Q

Bone Marrow Aspiration

  • In a bone marrow aspiration, an MD uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the posterior iliac crest. A bone marrow biopsy is often taken at the same time. The second procedure (the biopsy) removes a small piece of bone tissue and the enclosed marrow
A

Nursing Considerations

  • Assess for pain, bleeding, and infection at the site
  • Apply pressure to the site post-op and a pressure dressing
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6
Q

4 Types of Leukemias

  • Acute Myelogenous (AML)
  • Acute Lymphocytic (ALL)
A
  • Chronic Myelogenous (CML)
  • Chronic Lymphocytic (CLL)
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7
Q

?

Is the most common type of leukemia in people 50+ and may have a hereditary component

A

CLL (Chronic Lymphocytic)

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8
Q

?

Is a leukemia common in children with median age of 10 years old

A

ALL (Acute Lymphocytic)

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9
Q

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Is a leukemia that doesn’t usually occur in children; rather uncommon in that age group
- Typically affects older adults and is caused by a chromosomal mutation that happens spontaneously

A

CML (Chronic Myelogenous)

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10
Q

?

Is the most common leukemia occurring in adults; “adult onset”
> Median age of 65

A

AML (Acute Myelogenous)

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11
Q

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An uncontrolled proliferation of lymphoblasts from lymphoid stem cells
* Most common in children

  • Fever, fatigue, bleeding
  • Treatment - chemotherapy (methotrexate [MXT]), BMT (bone marrow transplant)
    > MXT used prophylactically due to CNS involvement; given intrathecally or used with cranial radiation
A

ALL

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12
Q

?

  • Most common adult onset leukemia; peak incidence is age 60
  • Prognosis variable
  • Fever, infection, fatigue/weakness, bleeding, bone pain [ ! biggest risk from death is from infection or bleeding]
  • Chemotherapy, BMT; supportive treatment = blood transfusions, antibiotics

! Isolation Precautions due to risk of infection

A

AML

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13
Q

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  • More common in older adults (M>F; >50 y.o.); survival 2-14 years
  • Malignant B lymphocytes
    > Cells are mature, immature, do not die so there is an overaccumulation happening
  • “B” symptoms, swollen lymph nodes
    > Fever >101.5°, drenching sweats, weight loss
    > If found early and symptoms are mild, may be no treatment; may just do supportive
  • Chemotherapy (for late-stage cases)
A

CLL

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14
Q

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Philadelphia chromosome; BCR-ABL gene
> Specific to section of DNA missing from chromosome 22 - missing in 90-95% of patients

  • General malaise, anorexia, weight loss, and enlarged and tender, painful spleen and liver
    > Median age 55-60; uncommon in those <20
    > Life expectancy 3-5 years

Tyrosine kinase protein
* 3 stages (chronic/accelerated/blast)

  • Treatment = Gleevec (Imatinib) or Dasatinib (Sprycel); chemotherapy (MXT) combo or BMT
A

CML

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15
Q

?

Is an abnormal overgrowth of lymphocytes
- Primarily tumors of lymphatic system

What are the 2 types of?

A

Lymphoma

Hodgkin’s; non-Hodgkin’s lymphoma (NHL)

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16
Q

Lymphomas are tumors of the lymphoid tissue, thymus, bone marrow, or secondary tissue lymphoid, spleen, tonsils, intestinal lymph tissue

A
17
Q

?

Consists of all other cancers originating from lymphoid tissue

  • Any lymphoid cancer that does NOT have Reed Sternberg cells
  • Causes unknown; may be associated with viral infections, radiation, autoimmune disorders and toxic chemicals
  • Incidence increases with age and average age is 50-60
A

Non-Hodgkin’s lymphoma

  • There are more than 12 types but generally treated all the same
  • Spreads throughout lymphatic in a less orderly way than Hodgkin’s; represents 3% of cancer deaths in the US
  • Treatment determined by type and stage of disease and can include chemotherapy, radiation, BMT, or Interferon
18
Q

?

Is a cancer that starts in a single lymph node or a single chain of lymph nodes

> Has a relatively rare malignancy and pretty high cure rate; M>F; in teens and young adults there’s peak incidence; exact cause unknown

> Higher incidence in someone with a first-degree relative that have the disease or people who have chronic immunosuppressive therapy
- i.e., patient with a renal transplant; veterans exposed to agent orange or someone with a h/o EBV (are going to have a higher risk)

! Reed Sternberg cell

! s/s painless enlarged lymph node on neck; “B” symptoms

A

Hodgkin’s lymphoma

19
Q
  • First sign is a painless, enlarged lymph node on the side of the neck; unilateral. Is a single node in the beginning; node is firm, but not hard and painless
  • If you have B symptoms and a painless lymph node, your prognosis is poorer than if you just had lymph node enlargement
  • Is 1 of the most treatable types of cancers if found early
A
  • First step is staging = Arbor staging criteria
  • For diagnosis, a lymph node biopsy is performed; looking for presence of Reed-Sternberg cells
  • Treatment will involve external radiation; radiation of the involved lymph node region, chemotherapy, or a combination of both
    > One of the complications of radiation to this region is burns on the neck (can impact swallowing = consider feeding tube)
20
Q

Hodgkin’s Lymphoma = Treatment

  • Staging
  • Chemotherapy
  • Radiation

! Diagnosis = lymph node biopsy - presence of Reed Sternberg cells

A
21
Q

?

Is a reduced # of platelets below the average range of 150,000 to 450,000/mm3
> A count <150,000 puts the patient at risk for excessive bleeding (consider safety and institute fall precautions)

  • Not a disease but rather a complication of other disorders
  • Occurs as a result of decreased platelet production in the bone marrow or increased platelet destruction
    > Antibodies that increase platelet destruction may be genetic, acquired, or medication-induced
A

Thrombocytopenia

22
Q

Thrombocytopenia - Disorders

  • Acute ___ may occur between ages __-__
  • Chronic ___ occurs most often in women between ages __-__
A

ITP; 2-6

ITP; 15-40

23
Q

?

Is a hereditary disorder carried by females on the X chromosome and is the body’s inability to appropriately clot; leads to excessive bleeding as well

A

Hemophilia

24
Q

___ usually follows a viral infection or immunization in children

Clinical manifestations = easy bruising and petechiae; bleeding from nose, gums, GI/GU tract; severe cases = bleeding in vital organs like brain (! fatal)

Management = treatment depends on the level of thrombocytopenia present

A

ITP

25
Q

In adults, ITP can be medication-induced or secondary to an autoimmune disorder

In all cases, there is some sort of immune system dysfunction where anti-platelet antibodies are formed which increases platelet destruction rather than having the typical 7-day lifespan (may be destroyed in a matter of hours)

! If thrombocytopenia becomes more profound, treatment is with ___

A

glucocorticoids

26
Q
  • Risk of hemorrhage is a major complication with any condition that results in thrombocytopenia
A
  • Severity of thrombocytopenia determines whether there’s a risk of spontaneous bleed; although the clinical manifestations initially are ecchymosis and petechiae as the platelet count decreases, normal activities like brushing your teeth or sneezing may induce spontaneous bleeding

NUR 201 Week 3 (3 decks)

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