Leukemia Flashcards
What is leukemia ?
type of cancer that occurs in the bone marrow resulting in abnormal WBCs that impair the body’s ability to fight infection
- bone marrow produces both myeloid & lymphoid stem cells
- most common childhood cancer
What is leukopenia ?
reduction in WBC
What is leukocytosis ?
increase of WBCs
What is neutropenia ?
low neutrophils
What is thrombocytopenia ?
low or absence of platelets
What are the importance of neoplastic disorders ?
- leading cause of death from disease in children past infancy
- almost half of all childhood cancers involve blood or blood-forming organs
What are some consequences of leukemia ?
bone marrow consequences
- anemia
- infection (neutropenia)
- bleeding (thrombocytopenia)
What are some nursing assessments for anemia ?
decrease in O2-carrying component of RBC
- assess general well-being, eval weakness, assess skin color, eval labs, monitor VS
- S&S: inability to perform ADLs, fatigue, pallor, paleness, decreased sats
- interventions: transfusion, conserve energy, balance rest and activity, comfort, give O2
What are some nursing assessments for infection ?
WBCs necessary for fighting and resisting infection
- monitor VS, monitor S&S of infection, assess skin integrity, monitor ANC
- interventions: preventative nursing care, implement neutropenic precautions
- S&S: increased temp, skins of local infection is edema and redness
What are some nursing assessments for bleeding ?
decrease in platelets, necessary for normal coagulation
- examine: skin and mouth for bleeding, & blood in stool, urine, and emesis, monitor VS, assess changes in LOC. monitor platelet count
- S&S: oozing around gums, petechiae, bruising, decreased LOC related to intracranial bleed, signs of new or old blood in body fluids
- interventions: transfusion, avoid trauma, apply extended pressure, avoid restrictive clothing, no rectal temps or meds
What are some diagnostic tests for leukemia ?
- Hx and physical examination
- S&S of bone marrow suppression
- CBC with differential and platelet (d/p): will show S&S of anemia, thrombocytopenia, & neutropenia
- peripheral blood smear
- bone marrow aspiration: will demonstrate an over population of blast cells
- lumbar puncture: done after diagnosis is confirmed to see if there is CNS involvement
- ANC
How do we calculate the absolute neutrophil count (ANC) ?
Total WBC X (% neutrophil + % bands)
- neutropenia= ANS<1,000
Why are bone marrow results important ?
it shows hypercellularity with sheets of small blasts
- you can see the different cells that may mean leukemia
- increase in blast cells indicated leukemia
What age group has the better prognosis ?
kids 2 yrs to 9 yrs
What are the treatment options for ALL (acute lymphycytic leukemia)?
- chemo: use combo chemo drugs to stop cancer at several points in cycle (IV and intrathecal)
- steroids
- blood transfusions
- hematopoietic stem cell transplant (HSCT)
What are the 4 phases of chemo ?
- induction
- CNS prophylactic
- intensification
- maintance
What are some admin for chemo ?
- IV
- venous access device
- central line: port-a-cath
- PO
- intrathecal
What are some cell cycle non-specific meds ?
Alkylating agents
- cyclophsphamide
What are some targeted meds ?
Kinase inhibitors
- Dasatinib, imatinib
What are some SE of chemo ?
- myelosuppression (anemia, thrombocytopenia, neutropenia)
- nausea & vomiting
- anorexia
- mucositis/stomatitis
- neuropathy
- hemorrhagic cystitis
- alopecia
- delayed puberty
Why may steriods be used ?
helps to promote sense of well-being and increase appetite
- prednisone or dexamethasone
- SE: moon face, mood changes, HTN, hyperglycemia
What is an acute hemolytic transfusion reaction ?
immediate reaction to blood transfusion
- results from transfusion of incompatible blood products
- can be mild or life-threatening
What is the nurses responsibilities for transfusion reactions ?
- stop transfusion
- maintain a patent IV line with NS
- notify Dr and blood bank immediately
- recheck identifiers of pt and blood
- monitor VS and urine output
- treat any symptoms per physician orders
- save blood bag and tubing, send back to blood bank
- collect blood and urine specimens as ordered or per policy
- document transfusion reaction on the blood form and in pt’s chart
What are some characteristics of Hematopoietic Stem Cell Transplant (HSCT) ?
- donors: may be relatives or nonrelatives
- antigen matched or mismatched
- used to establish healthy cells in both malignant and nonmalignant disease
- peripheral stem cells: may be used or umbilical cord blood
- ablative therapy
- stem cells admin
- newly transfused stem cells repopulate ablated bone marrow
- graft v. host disease: rejection of donor marrow
