Hematology Continued Flashcards
It all starts w/ a change in a cell in the bone marrow. What hematological disorder is this?
Leukemia
What are the Four Common Types of leukemia?
- Chronic lymphocytic leukemia aka CLL, 2. Chronic myeloid leukemia aka CML,
- Acute lymphocytic leukemia aka ALL,
- Acute myeloid leukemia aka AML.
CLL has about 7,000 cases a year and happens mostly to people over the age of 65 and almost never in children. CML about 4,400 cases a year and mainly affects adults. ALL about 38,000 cases a year, it’s the most common type in young children but it can also affect adults.
The younger the leukemia patient is the better their chance of recovery and you see about a 98% cure rate of ALL in children and it drops to about 85% for adults so that’s really awesome because 35 years ago it was incurable and 100% of the people died from it. AML about 10,000-11,000 cases a year and it occurs in both adults and children, again prognosis is better w/ a child and interestingly people w/ _______ are more at risk for AML.
DOWN syndrome
Radiation exposure like from nuclear power plant accidents, atomic bomb explosions and unfortunately we see too much of both in our life span. (Story: actors dying from atomic bomb exposure near where filming).
This is a risk factor for what hematological disorder?
Leukemia
Working with chemicals:
Ex. benzene, formaldehyde.
This is a risk factor for what hematological disorder?
Leukemia
Chemotherapy can cause this disorder in later years.
This is a risk factor for what hematological disorder?
Leukemia
Down’s syndrome causes this because there are some abnormal chromosomal disorders that cause that to happen.
This is a risk factor for what hematological disorder?
Leukemia
Human T-cell leukemia virus can lead to this also and it’s not contagious.
This is a risk factor for what hematological disorder?
Leukemia
Myelodysplastic syndrome which is a group of disorders in which the bone marrow just doesn’t produce enough healthy blood cells. It all starts w/ a change in a cell in the bone marrow.
This is a risk factor for what hematological disorder?
Leukemia
Most people who have known risk factors don’t get _______ and many who get it don’t have any risk factors. Use that information however you see fit.
Leukemia
Fever or night sweats, frequent infections, feeling weak or tired, headache, bleeding/bruising, bone and/or joint pain, abdominal swelling or discomfort, swollen lymph nodes, weight loss.
These are the signs and symptoms of what hematological disorder?
Leukemia
Study Tip: All of these symptoms can also be attributed to a lot of other diseases, so what this means that if any of these symptoms occur they really need to be seen by a doctor.
In early stages of ______ leukemia cells can often function normally and they may have no symptoms at all and often time it is diagnosed during an appointment and they’ll do a CBC or something and find it before they have any symptoms.
Chronic
Acute symptoms of leukemia appear early and they get worse quickly and a lot of time people will go to the Dr. because they feel sick. In addition to these symptoms here with acute they can also have vomiting, confusion, seizures, and also sores in the eyes or on the skin, so they’re more likely to go to the Dr. w/ acute symptoms of leukemia rather than someone who has ______ leukemia.
Chronic
Chemotherapy Radiation therapy Biological Therapy Bone Marrow Transplant These are the treatments for what hematological disorder?
Leukemia
Biological therapy which is the use of medications that adjust the body’s natural responses to the disease process, so things that enhance their immunity. Ex. interferon medication. This is the treatment for what hematological disorder?
Leukemia
Bone marrow transplant with the Goal of remission.
This is the treatment for what hematological disorder?
Leukemia
______ Leukemias can be cured.
______ Leukemias are managed.
Acute
Chronic
With _____ lot of times people aren’t diagnosed until they’re in their 70’s- mid70’s and their life expectancy w/ treatment is 15 years so that’s pretty good. They can feel okay for most of that time.
Chronic lymphocytic leukemia
Can be Oral or IV through a peripheral or central line or into CSF if cells are found in CSF it can be done through spinal injections or through something called an __________. What is the name of this treatment for leukemia?
Chemotherapy
Ommaya reservoir
This is showing you what an _________ is and you see there is a little port there that’s been implanted and the little catheter goes down into the ventricles.
Ommaya Reservoir
This medication is given because in response to this treatment of leukemia the patient will not have enough WBCs and _______ increases that number.
colony stimulating factor
Study Tip: This is a classification of drugs that are given the abbreviation CSF don’t confuse this w/ cerebrospinal fluid.
Action: Stimulates production of granulocytes and macrophages.
Pharmacokinetics: Unknown
What medication has this action?
colony stimulating factor
Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)
Sargramostim (Leukine)
These are what classification of medications?
colony stimulating factor
Remember they’re stimulating granulocytes so gra-stim, granulocyte stimulation. Look at the name you can kind of tell it’s simulating something and remember that it is granulocytes and look at Neulasta it’s called that because it lasts longer
Aplastic anemia secondary to chemotherapy.
This is an indication that your patient might need what classification of medication?
Colony stimulating factor
Acceleration of bone marrow recovery in malignant lymphoma and Hodgkin’s disease.
This is an indication that your patient might need what classification of medication?
Colony stimulating factor
Delayed or failed bone marrow transplant so somebody gets a bone marrow transplant and they will give this to stimulate production of WBCs.
This is an indication that your patient might need what classification of medication?
Colony stimulating factor
Increase WBC’s in patient’s taking Zidovudine.
This is an indication that your patient might need what classification of medication?
Colony stimulating factor
Study Tip: That is an anti-retroviral given to people w/ HIV.
Filgrastim and pegfilgrastim are ________ in patients with hypersensitivity to E. coli derived proteins or other components of drug.
contraindicated
FYI
_________ is also derived from using E. coli so if there is a previous hypersensitivity reaction to that they can’t receive it.
Growth hormone
FYI
______ is contraindicated if the pt had excessive leukemic myeloid blasts (>10%) in bone marrow or blood, hypersensitivity, pts receiving cytotoxic chemo or radiation within 24 hrs before or after the dose.
Sargramostim
FYI
Respiratory symptoms and that’s with Pegfilgrastim.
What classification of medications has this adverse reaction?
Colony Stimulating Factor
Bone pain with both Filgrastim and Pegfilgrastim.
What classification of medications has this adverse reaction?
Colony Stimulating Factor
Myalgia is caused because the bone pain and the Athralgia because production has been increased and the activity can cause some congestion and pain in the bone.
What classification of medications has this adverse reaction?
Colony Stimulating Factor
Supraventricular arrhythmias. Anorexia, nausea, vomiting. Diarrhea. Stomatitis. Fluid retention. What classification of medications has this adverse reaction?
Colony Stimulating Factor
Study Tip: This can be a very uncomfortable injection and it’s not your technique it’s that the medication does cause some discomfort
Excessive leukocytosis so you will want to watch your labs when you’re giving this and you’ll want to check your labs before you give it.
What classification of medications has this adverse reaction?
Colony Stimulating Factor
Lithium, Corticosteroids, other drugs
may potentiate the myeloproliferative effects of ________ which once again tells you check your labs before you start the medication and while it’s being given.
Sargramostim and other colony stimulating factor.
Study Tip: Everything interacts w/ Lithium so if you ever have a patient on lithium you need to be very careful.
Monitor WBC’s.
Monitor for signs and symptoms of infection.
______ this medication when ANC is 10,000 for filgrastim and 20,000 for Sargramostim.
These are the nursing responsibilities for what classification of medication?
Colony Stimulating Factor
D/C
Study Tip: Don’t memorize the #’s, what’s important for you to know is that we watch the count and there’s a time we stop it because of what those counts say. This is when the neutrophils go back up.
Know that _________ is LONGER acting than ________. Teach importance of balanced diet and maintaining compliance with this therapeutic regimen
pegfilgrastim
filgrastim
Assessment:
Risk factors
Symptoms they have had.
Physical assessment you look for enlarged lymph nodes.
Monitor CBC (attention to WBCs).
- This is Before and After care for a Bone Marrow Biopsy.
These are the nursing interventions for what hematological disorder?
Leukemia
The ________ procedure is difficult to watch because they use a very large needle and go straight down into the bone, she has seen it done in the hip, pelvis, or the sternum and it just looks kind of barbaric. They’ll put that needle down into the bone and then aspirate out a piece of bone marrow and make a slide out of that and send it to the lab.
Bone marrow biopsy
As the nurse you need to explain you’ll be there during the ________procedure, and the Dr. will explain the procedure, and help comfort the patient, and afterwards you’re going to be monitoring the site. It’s not a comfortable procedure.
Bone marrow biopsy
1 is Risk for infection they have messed up WBCs, maybe they’re neutropenic, and neutrophils are the very first responders. If you get a splinter or something in your finger, normally there are more neutrophils at that site in seconds, like a minute and a half so if you don’t have that fast reaction time you may have delayed responses to infection. This is the nursing diagnosis for patients with what hematological disorder?
Leukemia
Fatigue from treatments, if they’re anemic they aren’t getting enough oxygen.
This is the nursing diagnosis for patients with what hematological disorder?
Leukemia
Who wouldn’t have Fear & Anxiety? Fear of dying, anxiety about treatments and what’s going to happen to me.
This is the nursing diagnosis for patients with what hematological disorder?
Leukemia
Anxiety is vaguer than fear, fear is more specific.
Altered nutrition (Study found no benefit to a neutropenic diet). This is the nursing diagnosis for patients with what hematological disorder?
Leukemia
Educate on the disease process. It’s really nice that we have so many computer programs now that we can just print it up and read it first and make sure you understand it before you talk to the patient.
These are the nursing interventions related to what hematological disorder?
Leukemia
The physician should have done this but you can reinforce it and help explain to them things that they don’t understand. If someone told her she had leukemia she probably wouldn’t listen much after that because she’d be so freaked out. While the physician might do a fantastic job explaining it, if the pt is unable to listen it won’t do any good.
Educate the patient on precautions: Radiation Chemotherapy Infection prevention Hand washing is important These are the nursing interventions related to what hematological disorder?
Leukemia
Be truthful, people know if you’re lying to them and if there is something you can’t say just tell them they have to talk to their dr. about it. Things that you can be truthful about be truthful and that will help them trust you.
These are the nursing interventions related to what hematological disorder?
Leukemia
Offer them emotional/psychological/spiritual support and sometimes all that means is your presence and don’t underestimate just being there for you patient and let them just know someone is there. Sometimes patients are so focused on this not being hard on their families that they don’t really take care of themselves.
These are the nursing interventions related to what hematological disorder?
Leukemia
Administer prescribed medications: Ex. chemo. Once you are chemotherapy certified.
These are the nursing interventions related to what hematological disorder?
Leukemia
Multiplication of abnormal plasma cells- These are B-cells which are one of the types of WBCs. The # of plasma cells gets raised to much higher level because they normally make proteins this makes the level of abnormal proteins in the blood go up.
What hematological disorder is this?
Multiple Myeloma
This disorder may affect the patient’s bones, immune system, kidneys, and RBCs. What hematological disorder is this?
Multiple Myeloma
The cause of _______ is unknown, the pt may not always show symptoms so if there aren’t symptoms they might just monitor the pt. Because those cells can circulate throughout the blood they can go to other places in the body, Pathobreeze showed bones effected by multiple myeloma.
multiple myeloma
Important: look at pathobreeze
This disorder is called ________ because it can spread throughout the body damaging bones, surrounding tissues, and can interfere w/ the immune system’s ability to fight infection because it interferes w/ the production of antibodies.
Multiple Myeloma
Age, sex, and race.
The majority of people who develop multiple myeloma are over 50, most are in their mid-60’s,
men are more likely to develop it.
African Americans are about 2x as likely to develop it as are Caucasians.
These are the risk factors for what hematological disorder?
Multiple Myeloma
There might be a history of monoclonal gammopathy of undetermined significance (MGUS) that’s just a blood protein that’s in the blood and about 1% of people w/ MGUS develop it.
These are the risk factors for what hematological disorder?
Multiple Myeloma
Study Tip: Other risk factors are obesity, radiation exposure, and working in petroleum related industries.
Bone pain: especially in the back, pelvis, ribs, and skull. Unexplained fractures.
Weakness or numbness in the legs can also occur.
These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
Symptoms vary from person to person, they may be asymptomatic at first & symptoms develop as the disease progresses
Repeated infections like sinusitis, bladder and kidney infections, pneumonia, skin infections, and shingles.
Unexplained, unintended weight loss.
These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
Abnormal proteins in blood. M proteins are found in blood. Bence Jones Proteins are (found in urine) these are all tumor markers for this disorder.
These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
Hypercalcemia can occur because bone is being destroyed so as the bone is being destroyed the calcium is dissolved into the blood. These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
If they have hypercalcemia the signs and symptoms can include polydipsia, polyuria, constipation, nausea, anorexia, they could also have confusion.
These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
Anemia can also develop along with those anemia related symptoms like fatigue. On x-ray their bones might look thinner and this will be diagnosed with a bone marrow aspiration to look for abnormal cells.
These are the signs and symptoms of what hematological disorder?
Multiple Myeloma
Impaired immunity results so they are more likely to develop infections.
This is a complication related to what hematological disorder?
Multiple Myeloma
REMEMBER: B-cells are a very important part of the immune system.
These myeloid cells inhibit the production of antibodies and it makes you more susceptible to the infections. Ex. Sinusitis
This is a complication related to what hematological disorder?
Multiple Myeloma
Bone problems include erosion of bone marrow, fractures, spinal cord compression which is an emergency and signs of that include weakness and even paralyses in their legs which needs to be addressed immediately because permanent paralyses can occur.
This is a complication related to what hematological disorder?
Multiple Myeloma
Impaired renal function. There will be higher calcium levels in the blood because of the eroding bone can interfere w/ the ability to filter out waste. There will also be abnormal proteins and a high number of proteins which are difficult to filter
This is a complication related to what hematological disorder?
Multiple Myeloma
Anemia which we mentioned earlier, cancer cells crowd out normal blood cells in the blood stream and multiple myeloma can cause blood disorders as well as blood problems.
This is a complication related to what hematological disorder?
Multiple Myeloma
Chemotherapy. Corticosteroids. Radiation. Stem cell transplant. This is the treatment for what type of hematological disorder?
Multiple Myeloma
Study Tip: If the patient is Asymptomatic then just monitor.
Radiation to spleen and the brain if the abnormal cells are found in the brain then they will do total body before _______ in a patient with multiple myeloma.
Bone marrow transplantation
What treatment is this related to multiple myeloma?
Bone Marrow Transplantation
FYI
Umbilical stem cells, Bone marrow stem cells, or Peripheralstem cells. Otologist stem cells are removed from the pt and then they treat them to kill any abnormal cells, they freeze it, store it, and then the patient gets high doses of chemo and radiation to kill their bone marrow and then they get those same cells infused back into them. What treatment is this related to multiple myeloma?
Bone Marrow Transplantation
FYI
Infection and Bleeding
side effects from high doses chemo and radiation
Transplant reactions
These are the side effects of what treatment related to multiple myeloma?
Bone Marrow Transplantation
FYI
_________ is a disorder that effects the lymphatic system. The lymph nodes contain lymphocytes and macrophages. They produce antibodies and sometimes those nodes might become enlarged because of hyperactivity on there.
Hodgkin’s Disease
Diagnosis and treatment is going to depend on the type of lymphoma that a patient has and it’s usually classified as either _________ or _________.
Hodgkin’s lymphoma or Non-Hodgkin’s lymphoma
The diagnosis and also staging of ________ is done by lymph node biopsy, bone marrow biopsy, CT of the chest, and PET scan.
Hodgkin’s Disease Study Tip: if you remember in the video we watched in class she only had lymphoma above the diaphragm which is a good sign because the less that it has spread than the better the outcome of treatment.
Treated usually with radiation unless it is advanced then they go to chemo.
This is the treatment for what type of Hodgkin’s Disease?
Hodgkin’s
What is the benefit of having Hodgkin’s Disease?
BENEFIT: Hodgkin’s has a very orderly spread of the disease. This is also First cancer to be cured by radiation alone.
Reed-Sternberg cells. The pathologist looks for those cells when they’re doing a diagnosis to specify which type of disease this patient has.
These are commonly seen in what hematological disorder?
Hodgkin’s Disease
With this type of lymphoma there are over 40 different types. Each type is a little different so it’s HARDER to treat and the course of treatment varies according to which type of lymphoma the patient has. This is the treatment for what type of Hodgkin’s Disease?
Hodgkin’s
________ is a decreased number of platelets that is either congenital or acquired > more common.
Thrombocytopenia
Can be caused by:
Decreased platelet production.
Increased destruction.
Sequestration > trapped out of circulation.
Blood loss.
These are causes of what hematological disorder?
Thrombocytopenia
Medications can also cause thrombocytopenia, and DO NOT FORGET __________ can cause thrombocytopenia so you need to monitor your patients platelet level when giving this medication.
Lovenox/Enoxaparin
Sudden onset of petechiae (may be only symptom).
Malaise.
Fatigue.
General weakness.
These are the symptoms of what hematological disorder?
Thrombocytopenia
Get a blood draw to look at the number of platelets and they’ll be on bleeding precautions because platelets are required for clotting.
This is a nursing intervention for a patient with what hematological disorder?
Thrombocytopenia
Administer platelets PRN. Some Drs will administer them below when the platelets get below 50,000 and has seen that sometimes they will wait until the patientgets down below 20,000 to administer platelets so you as the nurse need to be careful and utilize bleeding precautions.
This is a nursing intervention for a patient with what hematological disorder?
Thrombocytopenia
This will involve education of the pt, avoiding IM injections, soft toothbrush, and electric razor for shaving.
This is a nursing intervention for a patient with what hematological disorder?
Thrombocytopenia
Making a safe environment because someone could bump into something and if their platelets are low enough they can really get into some problems, particularly if they bump their head. She has seen on more than one occasion someone bumping their head and dying from that and a bump you don’t think would be fatal. (Story: Friend who banged head, had a slow bleed and ended up dying.)
This is a nursing intervention for a patient with what hematological disorder?
Thrombocytopenia
Be careful and protect patients who are at risk for bleeding, protect them all but be extra cautious when they’re at risk for bleeding.
This is a nursing intervention for a patient with what hematological disorder?
Thrombocytopenia
