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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
What is used if bone marrow transplant is not an option?
Intensification
26
What is done in intensification?
Use of diff drugs to prevent cross resistance for about 2yrs
27
What is a normal neutrophil count?
50-60
28
What is nadir of chemotherapy?
When WBC is the lowest
29
What is given in a pt with tumor lysis syndrom to avoid uric acid crystals and lysis?
Allopurinol
30
Neutropenic pt's are @ high risk for infection; what are the major sites?
Oropharynx, esophagus, sinuses, lungs, skin and perirectal area
31
In neutropenia what kind of s/s appear in the mouth?
Redness, ulcers
32
In neutropenia what kind of s/s appear in the resp. tract?
cough, sputum, abnormal breath sounds
33
In neutropenia what kind of s/s appear on the skin?
Wounds, breakdowns @ CVL or IV sites
34
In neutropenia what kind of s/s appear in the urinary tract?
Burning, frequency, cloudiness
35
What is the #1 symptom in infection?
FEVER
36
Delay in only hours in the treatment of neutropenic pt's can exhibit s/s of systemic infection that can result in what?
Septic shock and/or death
37
What are major complications of high-dose treatment usually from Cytarabine (ARA-C)?
Cerebellar toxicity: ataxia, nystagmus, dysarthria, inability to perform rapid alternating movements
38
What is needed prior to each high dosing chemo dose?
Neuro check
39
What type of leukemia is most common in children?
Acute lymphoid leukemia (ALL)
40
What are the manifestations of ALL?
Elevated WBC w/ lymphocytosis, bone pain and CNS involvement
41
If ALL occurs in adults it is bc of what?
Prior diagnosis
42
Treatment for ALL is mostly the same as AML; what's the only diff?
CNS prophylaxis- intrathecal methotrexate
43
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)?
Bone marrow suppression
44
What is the major complications of leukemia treatments?
Neutropenia, tumor lysis syndrome, cerebellar toxicity, bone marrow suppression
45
What is the biggest problem in tumor lysis syndrome?
Increase potassium and phosphate and decrease calcium
46
What are the 3 major sites prone to infection from neutropenia?
Resp., mouth, and central line
47
What are the major manifestations of thrombocytopenia?
Bruising, black stools, abd distention/pain, brain bleed causing severe HA and change in LOC
48
These complications are from what: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and renal failure?
Tumor lysis syndrome
49
@ what # of platelet can spontaneous bleeding start occurring?
10,000-20,000
50
Increase in potassium is very harmful and can cause what?
Dysarthrias and possible death
51
What is added to the fluids for tumor lysis syndrome to avoid uric acid crystals?
Sodium bicarbonate
52
What level of pH should the urine be?
7-8
53
What is the treatment for tumor lysis syndrome?
Aggressive hydration and urine alkalinization through Allopurinol and sodium bicarb fluids, diuretics, I/O, daily labs
54
Which type of leukemia is the least worse, has a slow onset and pt's live longer?
Chronic lymphocytic leukemia (CLL)
55
What type of leukemia goes through various stages and is associated w/ Philadelphia chromosomes?
Chronic Myelocytic Leukemia (CML)
56
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?
Chronic lymphocytic leukemia (CLL)
57
Which type of leukemia has these manifestations: fatigue, wt. loss, sweating, leukocytosis, splenomegaly and eventually converts to acute leukemia?
Chronic Myelocytic Leukemia (CML)
58
What is given to neutropenic pt's to increase WBC production?
Neupogen
59
What type of bone marrow transplant is from an identical twin?
Synergistic
60
What type of bone marrow transplant is from a matching sibling or donor?
Allogenic
61
What type of bone marrow transplant is from the individuals own stem cells?
Autologous
62
This complication only occurs in allogenic bone marrow transplant?
Graft vs. host disease
63
What is graft vs. host disease?
new stem cells from transplant attack the body (looks like severe burn)
64
Where does graft vs. host disease usually attack?
Skin, GI, liver
65
Besides graft vs host disease what is another complication of bone marrow transplant?
Mucositis
66
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?
Acute skin type
67
What type of graft vs. host disease has these manifestations: green watery severe diarrhea exceeding 2L/day, GI bleed, liver, RUQ pain?
Acute GI type
68
What type of graft vs. host disease occurs @ least 3mon after transplant, has pronounced inflammation and fibrotic changes, and mostly targets the skin?
Chronic type
69
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?
Mucositis
70
If mucositis is severe enough what may be required?
PCA/IV analgesics, TPN, and intubation or tracheostomy

NUR 200- Exam 1 (10 decks)

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