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Unit 4 > Leukemia > Flashcards

Leukemia Flashcards

1
Q

Leukemia

A

type of cancer with uncontrolled production of immature WBCs; bone marrow becomes overcrowded with immature nonfunctional cells and production of normal blood cells is greatly decreased

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2
Q

Lymphocytic/lymphoblastic cells

A

leukemic cells coming from the lymphoid pathways

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3
Q

Myelocytic/myelogenous cells

A

abnormal cells coming from the myeloid pathways

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4
Q

Biphenotypic leukemia

A

acute leukemia that shows both lymphocytic and myelocytic features

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5
Q

Possible risk factors for leukemia

A

ionizing radiation, viral infection, exposure to chemicals and drugs, bone marrow hypoplasia, genetic factors, immunologic factors, environmental factors, and interaction of these factors

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6
Q

Acute myelogenous leukemia (AML)

A

most common form of leukemia; diagnosed and classified on the basis of the number of healthy blood cells, the number of leukemic cells, and the specific chromosomal abnormalities identified in the leukemic cells; prognosis varies by subtype and chromosomal abnormality

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7
Q

Acute promyelocytic leukemia (APL)

A

common sub-type of adult onset AML; most curable of the adult AMLs

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8
Q

Acute lymphocytic leukemia (ALL)

A

most common in children; in adults, the Philadelphia chromosome (hallmark of chronic myelogenous leukemia) may be present

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9
Q

Chronic myelogenous leukemia (CML)

A

occurs more often in people older than 50; presence of the Philadelphia chromosome abnormality in the leukemic cells; has 3 phases

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10
Q

Chronic phase of CML

A

slowly progressing course; pt may have mild symptoms and respond to standard treatment

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11
Q

Accelerated phase of CML

A

spleen enlargement and progressive manifestation such as intermittent fevers, night sweats, and unexplained weight loss; lasts 6-12 mos

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12
Q

Blast phase of CML

A

indicates transformation to a very aggressive acute leukemia

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13
Q

Chronic lymphocytic leukemia (CLL)

A

most common type of chronic leukemia; occurs most in people over 50; survival time ranges from less than 19 mos to more than 10 years

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14
Q

Leukemia history assessment

A

exposure to risk factors and genetic factors; occupation and hobbies; previous illnesses and med history; changes in immune function; excessive bleeding episodes; weakness and fatigue

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15
Q

Integumentary manifestations of leukemia

A

ecchymoses, petechiae, open infected lesions, pallor of the conjunctivae, nail beds, palmar creases, and around the mouth, decreased tissue perfusion

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16
Q

Gastrointestinal manifestations of leukemia

A

bleeding gums, anorexia, weight loss, enlarged liver and spleen, constipation, decreased peristalsis

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17
Q

Renal manifestations of leukemia

A

hematuria

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18
Q

Cardiovascular manifestations of leukemia

A

tachycardia at basal activity, orthostatic hypotension, palpitations, murmurs, bruits

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19
Q

Respiratory manifestations of leukemia

A

tachypnea, dyspnea on exertion

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20
Q

Neurologic manifestations of leukemia

A

fatigue, headache, fever, cranial nerve problems, papilledema, seizures, coma

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21
Q

Musculoskeletal manifestations of leukemia

A

bone pain, joint swelling and pain

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22
Q

Psychosocial manifestations of leukemia

A

anxious and fearful; spend time with pt and family; learn pts expectations and feelings; assess coping patterns

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23
Q

Bone marrow aspiration and biopsy

A

definitive test for leukemia

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24
Q

Lab values of leukemia

A

abnormal WBC; decreased Hgb, Hct, platelets; abnormal clotting times and factors

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25
Q

Autocontamination

A

source of infection; normal flora overgrows and penetrates the internal environment

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26
Q

Cross contamination

A

source of infection; organisms from another person or the environment are transmitted to the pt

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27
Q

Induction therapy (acute leukemia)

A

combination chemotherapy started at the time of diagnosis; purpose is to achieve rapid, complete remission of all manifestations; side effect is severe bone marrow suppression with neutropenia; recovery of bone marrow function requires 2-3 wks; protect from life threatening infections

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28
Q

Consolidation therapy (acute leukemia)

A

another course of either the same drugs used for induction at a different dosage or a different combination of chemo drugs; intent is to cure; may be either single course or repeated courses of chemo; hematopoietic stem cell transplantation also may be considered

29
Q

Maintenance therapy (acute leukemia)

A

may be prescribed for months to years after successful induction and consolidation therapies; used for ALL and APL; purpose is to maintain remission achieved; maintenance drugs for ALL are milder; given orally for 2-5 yrs

30
Q

Treatment of chronic lymphocytic leukemia

A

standard chemotherapy; can cause remissions but does not cure; hematopoietic stem cell transplantation; curative potential or prolonged disease-free survival; comes with risk of mortality

31
Q

Drug therapy for infection

A

antibiotic and antibacterial drugs (aminoglycoside antibiotic, penicillin, third gen cephalosporin, vancomycin for MRSA), systemic antifungal drugs (recommended when neutropenic pt remains febrile 4-7 days after abx therapy), antiviral drugs (acyclovir)

32
Q

Antiviral drugs

A

used in pts with leukemia to prevent and treat viral infection; have serious side effects including ototoxicity and nephrotoxicity; monitor for hearing and kidney function impairment

33
Q

Protection from infection

A

extreme care during nursing procedures; no ill visitors/caregivers in room; strict asepsis; private room; no standing water; HEPA filtration; continually assess pt for infection; CBC daily; ANC daily; inspect mouth every shift; assess lungs for crackles; assess urine and urgency burning or pain with urination; VS Q4 hrs; obtain lab specimens as ordered; good hygiene; turn immobile pt hourly; apply skin lubricants; pulmonary hygiene Q4 hrs; cough and deep breathe hourly; neutropenic diet

34
Q

Hematopoietic stem cell transplantation

A

standard treatment; must have closely matched donor and be in temp remission after induction therapy; additional chemo given to purge the marrow of leukemic cells; new healthy stem cells are given to pt

35
Q

Allogenic bone marrow transplantation

A

transplantation of bone marrow from a sibling or matched unrelated donor

36
Q

Autologous transplantation

A

transplantation of pt receives their own stem cells collected before high-dose chemo

37
Q

Synergeneic

A

transplantation of identical sibling

38
Q

Phases of transplantation

A

obtainment and conditioning, transplantation, engraftment, and post-transplantation recovery

39
Q

Obtaining stem cells

A

bone marrow harvesting, peripheral blood stem cell harvesting, cord blood harvesting

40
Q

Bone marrow harvesting

A

marrow is removed through multiple aspirations from iliac crests; 500-1000 mL aspirated; filtered; treated to rid the marrow of any remaining cancer cells; allogeneic marrow is transfused immediately; autologous marrow is frozen for later use

41
Q

Pt care following harvest

A

monitor donor for manifestations of fluid loss; assess for complications of anesthesia; manage pain; hydrate with saline infusions before and after surgery; may need RBC transfusion; assess harvest sites for bleeding; analgesics

42
Q

Peripheral blood stem cell harvesting

A

three phases: mobilization, collection by pheresis, reinfusion; PBSCs are stem cells that have been released from the bone marrow and circulate within the blood

43
Q

PBSC mobilization phase

A

chemo or hematopoietic growth factors are given to pt; agents increase the numbers of stem cells and WBCs in peripheral blood

44
Q

PBSC pheresis phase

A

withdraw whole blood, filtering out the cells, and returning the plasma to the pt; 1-5 pheresis procedures are needed to obtain enough stem cells for transplant; cells are frozen and stored for reinfusion after regiment is complete; monitor for catheter clotting and hypocalcemia; monitor VS hourly during for hypotension;

45
Q

PBSC cord blood harvesting

A

obtaining stem cells form umbilical cord blood of newborns; high concentration of stem cells; drawn from umbilical vein following delivery and is stored in liquid nitrogen

46
Q

Conditioning regimen

A

“wipes out” the pts own bone marrow; gives higher than normal doses of chemo and/or radiotherapy to rid the person of cancer cells; 5-10 days is required

47
Q

Conditioning: days T-5 through T-4

A

high dose chemotherapy to obliterate the pts bone marrow cells and to kill of any remaining leukemic cells; dosages are much higher than normal chemo

48
Q

Conditioning: days T-3 through T-1

A

delivery of TBI (total body irradiation); 200 rads twice daily over 3 days; pt has all the expected side effects associated with chemo and radiation

49
Q

Late effects from conditioning regimen

A

can occur as late as 3-10 years after transplantation; include veno-occlusive disease, skin toxicities cataracts, lung fibrosis, second cancers, cardiomyopathy, endocrine complications, neurologic complications

50
Q

Transplantation

A

day T-0; marrow, PBSCs, or umbilical cord blood cells are thawed and infused through the pts central catheter

51
Q

Side effects of stem cell transfusions

A

fever, hypertension, red urine; administer acetaminophen and diphenhydramine before infusion; administer antihypertensives or diuretics to treat fluid volume changes

52
Q

Engraftment

A

PBSCs and marrow cells circulate briefly in the peripheral blood; stem cells find their way to the marrow-forming sites of the pts bones; stem cells must survive and grow in the pts bone marrow sites; takes 8-12 days for peripheral blood stem cell transplantation and 12-28 days for bone marrow stem cell transplantation; growth factors may be given; when engraftment occurs, WBC, RBC, and platelet counts begin to rise

53
Q

Engraftment monitoring

A

check pts blood for chimerism (presence of blood cells that show genetic profile or other marker that is different from those of the pt; progressive chimerism with increasing percentages of donor cells indicates engraftment

54
Q

Prevention of complications during transplantation

A

infection and bleeding precautions; help pt maintain hope, positive attitude and be involved in recovery

55
Q

Failure to engraft

A

donated stem cells fail to grow in the bone marrow and function properly; pt will die unless another transplant with stem cells is successful

56
Q

Graft-versus-host disease (GVHD)

A

immunocompetent cells of the donated marrow recognize the pts cells, tissues, and organs as foreign and start an immunologic attack against them; graft is attacking the host; presence of some GVHD indicates successful engraftment

57
Q

Management of GVHD

A

limit activity of donor T-cells by using drugs to suppress immune function

58
Q

Veno-occlusive disease (VOD)

A

blockage of liver blood vessels by clotting and inflammation; usually begins within the first 30 days following transplantation; manifestations include jaundice, pain in RUQ, ascites, weight gain, liver enlargement

59
Q

Management of VOD

A

supportive treatment only; early detection improves chance of survival; fluid management is crucial; assess daily for weight gain, fluid retention, increases in abd girth, and hepatomegaly

60
Q

Thrombocytopenia in AML

A

normal bone marrow production of platelets is limited; pt at great risk for excessive bleeding; can also be caused by induction therapy or high-dose chemo for transplantation; at extreme risk for bleeding at 50,000 and spontaneous bleeding at 20,000

61
Q

Management of thrombocytopenia

A

bleeding precautions; assess Q4 for bleeding, oozing, enlarging bruises, petechiae, or purpura; inspect stools, urine, drainage, and vomit for blood and measure accurately; measure abd girth daily; monitor lab values daily

62
Q

Bleeding precautions

A

handle pt gently; use lift sheet; avoid IM and venipunctures, use smallest gauge needle possible if unavoidable; apply firm pressure to any punctures for 10 minutes; apply ice to areas of trauma; test urine and stool for occult blood; observe IV sites Q2; avoid rectal trauma; measure abd girth daily; teach oral care; do not blow nose; avoid contact sports; wear shoes with firm soles when ambulating

63
Q

Conserve energy and improve RBC counts

A

nutrition therapy, blood transfusions, drug therapy, activity management

64
Q

Nutrition therapy

A

provide small frequent meals high in protein and carbs

65
Q

Drug therapy

A

colony-stimulating growth factors or erythropoiesis-stimulating agents for anemia and neutropenia; assess for side effects such as hypertension, headaches, fever, myalgia, and rashes

66
Q

Activity management

A

conserve pts energy; space care activities at least an hour apart and when pt has most energy

67
Q

Home care

A

visiting nurse for dressing changes and home transfusion therapy and chemotherapy; will spend 4-8 hrs per day in the home

68
Q

Pt teaching for self management

A

importance of continuing therapy and follow up; teach about infection prevention; teach safety and bleeding precautions

Unit 4 (4 decks)

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