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NUR 200- Exam 1 > Leukemia > Flashcards

Leukemia Flashcards

1
Q

Leukemia is most related to which type of anemia?

A

Aplastic anemia

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2
Q

What is leukemia?

A

A cancer of blood-forming tissues hindering body’s ability to fight infection

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3
Q

What are the 3 major probs in leukemia?

A

Uncontrolled proliferation of leukocytes, overcrowding of bone marrow, decreased production/function of normal blood cells

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4
Q

Which type of leukemia is this: undifferentiated or immature cells, abrupt and rapid onset?

A

Acute

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5
Q

Which type of predominant cell types is leukemia classified by?

A

Myeloid or lymphoid line of cells

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6
Q

What are some risk factors for leukemia?

A

Genetic predisposition, chromosomal abnormalities, chemicals, ionizing radiation, alkylating agents and other myelosuppressive drugs

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7
Q

What are blast cells?

A

Severely immature cells

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8
Q

What are the 3 major manifestations of leukemia?

A

Infections from decrease in WBC, Bleeding excessively/unexplained, and anemia symptoms

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9
Q

What type of s/s can fall under infections?

A

Fever, swollen gums, frequent infections and slow healing of cuts/wounds

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10
Q

What type of s/s can fall under bleeding?

A

Petechiae, brusing, bleeding of gums/nose/GI/GU

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11
Q

What type of s/s can fall under anemia?

A

Fatigue, SOB, pallor, can’t accomplish activities of daily living

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12
Q

What should be done prior to bone marrow biopsy?

A

Concent, check platelet ct/VS, pre-medicate w/ analgesics/anti-anxiety, assist to proper position (side lying)

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13
Q

What is the proper nursing care after the bone marrow biopsy?

A

Maintain pressure to site for 5-15min, bedrest for @ least 30min, assess puncture site for bleeding, ice pack, admin analgesics and assess site for infection

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14
Q

What type of leukemia is most common in adults?

A

Acute Myeloid Leukemia (AML)

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15
Q

What type of malignant cell is in AML?

A

Myeloblast

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16
Q

What does lab work usually reveal in AML?

A

Neutropenia and/or thrombocytopenia

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17
Q

What is AML usually diagnosed w/?

A

Bone marrow biopsy

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18
Q

What type of leukemia is when cells appear mature but lack normal function, has a gradual onset and a longer survival rate?

A

Chronic

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19
Q

What are the treatment stages for AML?

A

Induction chemotherapy, bone marrow biopsy, consolidation, and intesnification

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20
Q

In induction chemotherapy what is the regimen?

A

Antimetabolite (Cytarabine-ARA-C) slowly continuous infused for 7days and anthracycline for 3 days

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21
Q

What is the goal for induction chemotherapy?

A

Achieving remission

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22
Q

On what day of the beginning of treatment for AML would you do another bone marrow biopsy?

A

Day 14; if remission (no leukemic cells) move onto consolidation if no remission induction therapy again

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23
Q

How many rounds of consolidation is given?

A

3 very high dose of chemo (10xs more than induction) maybe 4g of cytarabine

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24
Q

What is meant to be prevented in consolidation and what is the goal?

A

Recurrence due to residual disease; bone marrow transplant

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25
Q

What is used if bone marrow transplant is not an option?

A

Intensification

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26
Q

What is done in intensification?

A

Use of diff drugs to prevent cross resistance for about 2yrs

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27
Q

What is a normal neutrophil count?

A

50-60

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28
Q

What is nadir of chemotherapy?

A

When WBC is the lowest

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29
Q

What is given in a pt with tumor lysis syndrom to avoid uric acid crystals and lysis?

A

Allopurinol

30
Q

Neutropenic pt’s are @ high risk for infection; what are the major sites?

A

Oropharynx, esophagus, sinuses, lungs, skin and perirectal area

31
Q

In neutropenia what kind of s/s appear in the mouth?

A

Redness, ulcers

32
Q

In neutropenia what kind of s/s appear in the resp. tract?

A

cough, sputum, abnormal breath sounds

33
Q

In neutropenia what kind of s/s appear on the skin?

A

Wounds, breakdowns @ CVL or IV sites

34
Q

In neutropenia what kind of s/s appear in the urinary tract?

A

Burning, frequency, cloudiness

35
Q

What is the #1 symptom in infection?

A

FEVER

36
Q

Delay in only hours in the treatment of neutropenic pt’s can exhibit s/s of systemic infection that can result in what?

A

Septic shock and/or death

37
Q

What are major complications of high-dose treatment usually from Cytarabine (ARA-C)?

A

Cerebellar toxicity: ataxia, nystagmus, dysarthria, inability to perform rapid alternating movements

38
Q

What is needed prior to each high dosing chemo dose?

A

Neuro check

39
Q

What type of leukemia is most common in children?

A

Acute lymphoid leukemia (ALL)

40
Q

What are the manifestations of ALL?

A

Elevated WBC w/ lymphocytosis, bone pain and CNS involvement

41
Q

If ALL occurs in adults it is bc of what?

A

Prior diagnosis

42
Q

Treatment for ALL is mostly the same as AML; what’s the only diff?

A

CNS prophylaxis- intrathecal methotrexate

43
Q

What is the term used to describe the decrease in production of cells responsible for providing immunity (leukocytes), carrying oxygen (erythrocytes) and/or those responsible for normal blood clotting (thrombocytes)?

A

Bone marrow suppression

44
Q

What is the major complications of leukemia treatments?

A

Neutropenia, tumor lysis syndrome, cerebellar toxicity, bone marrow suppression

45
Q

What is the biggest problem in tumor lysis syndrome?

A

Increase potassium and phosphate and decrease calcium

46
Q

What are the 3 major sites prone to infection from neutropenia?

A

Resp., mouth, and central line

47
Q

What are the major manifestations of thrombocytopenia?

A

Bruising, black stools, abd distention/pain, brain bleed causing severe HA and change in LOC

48
Q

These complications are from what: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and renal failure?

A

Tumor lysis syndrome

49
Q

@ what # of platelet can spontaneous bleeding start occurring?

A

10,000-20,000

50
Q

Increase in potassium is very harmful and can cause what?

A

Dysarthrias and possible death

51
Q

What is added to the fluids for tumor lysis syndrome to avoid uric acid crystals?

A

Sodium bicarbonate

52
Q

What level of pH should the urine be?

A

7-8

53
Q

What is the treatment for tumor lysis syndrome?

A

Aggressive hydration and urine alkalinization through Allopurinol and sodium bicarb fluids, diuretics, I/O, daily labs

54
Q

Which type of leukemia is the least worse, has a slow onset and pt’s live longer?

A

Chronic lymphocytic leukemia (CLL)

55
Q

What type of leukemia goes through various stages and is associated w/ Philadelphia chromosomes?

A

Chronic Myelocytic Leukemia (CML)

56
Q

Which type of leukemia has these early manifestations: anemia, enlarged lymph nodes/spleen, infections, WBC’s may be elevated and is treated w/ oral chemo and RT?

A

Chronic lymphocytic leukemia (CLL)

57
Q

Which type of leukemia has these manifestations: fatigue, wt. loss, sweating, leukocytosis, splenomegaly and eventually converts to acute leukemia?

A

Chronic Myelocytic Leukemia (CML)

58
Q

What is given to neutropenic pt’s to increase WBC production?

A

Neupogen

59
Q

What type of bone marrow transplant is from an identical twin?

A

Synergistic

60
Q

What type of bone marrow transplant is from a matching sibling or donor?

A

Allogenic

61
Q

What type of bone marrow transplant is from the individuals own stem cells?

A

Autologous

62
Q

This complication only occurs in allogenic bone marrow transplant?

A

Graft vs. host disease

63
Q

What is graft vs. host disease?

A

new stem cells from transplant attack the body (looks like severe burn)

64
Q

Where does graft vs. host disease usually attack?

A

Skin, GI, liver

65
Q

Besides graft vs host disease what is another complication of bone marrow transplant?

A

Mucositis

66
Q

What type of graft vs. host disease has these manifestations: macupapular erythema that may be pruritic, covers 25% of body, burn like wounds, and desquamation?

A

Acute skin type

67
Q

What type of graft vs. host disease has these manifestations: green watery severe diarrhea exceeding 2L/day, GI bleed, liver, RUQ pain?

A

Acute GI type

68
Q

What type of graft vs. host disease occurs @ least 3mon after transplant, has pronounced inflammation and fibrotic changes, and mostly targets the skin?

A

Chronic type

69
Q

Name this complication of bone marrow transplant: Profuse watery to thick ropy mucous, severe pain, bleeding ulcerations, infection, potential airway obstruction, xerostomia, sore throat, oral edema, difficulty talking, aspiration?

A

Mucositis

70
Q

If mucositis is severe enough what may be required?

A

PCA/IV analgesics, TPN, and intubation or tracheostomy

NUR 200- Exam 1 (10 decks)

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