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Medical Surgical Exam 4 > Leukemia > Flashcards

Leukemia Flashcards

1
Q

What is Leukemia?

A

A group of malignant disorders affecting the blood and
blood-forming tissues of

  • Bone marrow
  • Lymph system
  • Spleen
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2
Q

At what age does Leukemia occur?

A

Occurs in all age groups

Thought of as a childhood disease
Number of adults affected is actually 9 times that of children

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3
Q

How does Leukemia occur?

A

Accumulation of dysfunctional cells due to loss of regulation in cell division

Fatal if untreated

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4
Q

What is the cause of Leukemia?

A

No single cause
Combination of genetic and environmental influences

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5
Q

PAthophysiology of Leukemia picture

A
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6
Q

Classification of Leukemia

A

Acute versus Chronic

Based on type of WBC

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7
Q

Acute Leukemia

A

Acute: Clonal proliferation of immature hematopoietic cells

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8
Q

Chronic Leukemia

A

Chronic: Mature forms of WBC and onset is more gradual

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9
Q

Types of acute Leukemia

A

Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
Also called acute nonlymphoblastic leukemia (ANLL)

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10
Q

Types of Chronic Leukemia

A

Chronic myelogenous leukemia (CML)
Chronic lymphocytic leukemia (CLL)

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11
Q

Acute Myelogenous Leukemia (AML)

A

Abrupt, dramatic onset
Serious infection or abnormal bleeding
Uncontrolled proliferation of myeloblasts
Hyperplasia of bone marrow and spleen

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12
Q

Acute Lymphocytic Leukemia (ALL)

A

Most common type of leukemia in children
20% of acute leukemia in adults
Immature, small lymphocytes proliferate in the bone marrow-in children usually

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13
Q

Acute Lymphocytic Leukemia (ALL) S/S

A

Signs and symptoms may appear
Abruptly
Fever
Bleeding
Insidiously
Progressive weakness, fatigue, pain, bleeding tendencies
CNS manifestations are common-leukemic meningitis

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14
Q

Chronic Myelogenous Leukemia (CML)

A

Excessive mature neoplastic granulocytes in bone marrow
Move into peripheral blood in massive numbers
Ultimately infiltrate liver and spleen

_Philadelphia chromosome-
Diagnostic hallmark
Present in >90% to 95% CML patients_
Chronic, stable phase
Followed by acute, aggressive phase

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15
Q

Chronic Lymphocytic Leukemia (CLL)

A

Most common leukemia in adults
Production and accumulation of functionally inactive but long-lived, mature-appearing lymphocytes
B cell involvement
Lymphadenopathy is present throughout body

Complications from early-stage CLL are rare
May develop as disease advances
Pain, paralysis from pressure caused by enlarged lymph nodes

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16
Q

Leukemia Clinical Manifestations

A

Varied but usually related to
*Bone marrow failure
Overcrowding by abnormal cells-trouble with inadequate production of healthy cells
Inadequate production of normal marrow elements
Formation of leukemic infiltrates*

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17
Q

Leukemia Clinical Manifestations

Inadequate marrow elements cause

A

Anemia
Thrombocytopenia
Low to high number and altered function of WBCs

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18
Q

What happens as Leukemia progresses

A

, fewer blood cells are produced
Abnormal WBCs continue to accumulate
Leukemic cells may infiltrate organs

19
Q

Leukemic cells may infiltrate organs and lead to

A

Splenomegaly
Hepatomegaly

20
Q

Leukemic cells may cause

A

Lymphadenopathy- enlarged lymphnodes
Bone pain
Meningeal irritation
Oral lesions
Solid masses (chloromas)- Collection of leukemic cells

21
Q

What is Leukostasis

A

Life-threatening complication
Caused by a high leukemic WBC count in peripheral blood
Blood thickens and blocks circulatory pathways

22
Q

Leukemia Diagnostic Studies To diagnose and classify types of leukemia

A

Peripheral blood evaluation
Bone marrow examination

23
Q

Leukemia Diagnostic Studies To identify cell types and stage

A

Morphologic, histochemical, immunologic, and cytogenic methods

24
Q

Leukemia Diagnostic Studies To determine the presence of leukemic cells outside of blood and bone marrow

A

Lumbar puncture
CT scan

25
Q

Leukemia Interprofessional Care what is the initial goal

A

to attain remission
Complete, partial, or molecular
Prognosis is directly related to ability to maintain a remission
Prognosis becomes more unfavorable with each relapse

26
Q

Leukemia Interprofessional Care treatment

A

Chemotherapy
Induction: Aggressive TX- Watch for infection and bleeding complications
Postinduction or postremission (consolidation)- Another tx to get whatever remains
Maintenance

27
Q

Leukemia Interprofessional Care other treatments

A

Induction Therapy

Consolidation therapy

Maintenance Therapy

Corticosteroids
Radiation therapy

Immunotherapy and targeted therapy

28
Q

What is Induction Therapy

A

Attempt to induce remission
Seek to destroy leukemic cells in tissues, peripheral blood, and bone marrow
Patient may become critically ill
Provide psychologic support as well

Postinduction or Postremission chemotherapy

29
Q

What is Consolidation therapy

A

Started after remission is achieved
Eliminate remaining leukemic cells that may not be pathologically evident

30
Q

Maintenance Therapy

A

Lower doses of the same drugs given every 3 to 4 weeks
Goal is to keep body free of leukemic cells

31
Q

What is radiation therapy?

A

Total body radiation in preparation for bone marrow transplantation
Organ- or field-specific such as liver or spleen

32
Q

Leukemia Hematopoietic Stem Cell Transplant

A

Goal
Totally eliminate leukemic cells using combinations of chemotherapy with or without total body irradiation
Eradicates patient’s hematopoietic stem cells

33
Q

Leukemia Stem Cell Transplantation

A

Replaced with those of an HLA-matched-HUMAN LEUKOCYTE ANTIGEN MATCHED
Sibling-
Volunteer
Identical twin
Or replace with own stem cells

34
Q

Nursing Management Assessment Subjective data

A

Past health history
Exposure to toxins, chromosome abnormalities, frequent infections
Medications
Previous chemotherapy
Surgery or radiation treatments

35
Q

Nursing Management Assessment objective data

A

Fever, lymphadenopathy, lethargy
Pallor, jaundice, petechiae, ecchymoses
CV - tachycardia, systolic murmurs
GI - oral lesions-PRONE TO INFECTIONS or bleeding, herpes or infection, hepatomegaly, splenomegaly
Seizures, disorientation, confusion
Muscle wasting, bone or joint pain

36
Q

Nursing Management Assessment diagnostic findings

A

WBC may be normal or abnormal
Anemia
↓ Hct and Hgb
Thrombocytopenia
Philadelphia chromosome
Hypercellular bone marrow aspirate or biopsy

37
Q

Nursing Management Planning Overall Goals

A

Understand and adhere to treatment plan
Experience minimal side effects and complications of disease and treatment
Establish realistic hope and goals, feeling supported during periods of treatment, relapse, and remission

38
Q

Nursing Management Acute Care

Many physical and psychologic needs

A

Evokes great fear
Equated with death
Family may need help
Maximize physical function
Provide hope
Encourage discussion of concerns

Special challenges when meeting the intense psychosocial needs of a patient with leukemia
Patient empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life
Involve services of interprofessional team

39
Q

Nursing Management Acute Care

A

Review all drugs administered
Be prepared to manage the sometimes life-threatening side effects of treatment-severe infections, bleeding D/O-could bleed out
Assess lab data reflecting effects of drugs and sequelae of the disease

40
Q

Nursing Management Ambulatory Care

A

Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse

41
Q

Nursing Management Ambulatory Care

Teach patient and caregiver

A

Diligence in disease management
Need for follow-up care
When to seek medical attention- any worsening symptoms or S/S of infection

42
Q

Nursing Management Ambulatory Care

Goals of rehabilitation

A

Manage the consequences
Physical
Psychosocial
Social
Spiritual

43
Q

Nursing Management Evaluation Expected Outcomes

A

Cope effectively with the diagnosis, treatment regimen, and prognosis
Experience no complications related to the disease or its treatment
Feel comfortable and supported throughout treatment

44
Q
A

Medical Surgical Exam 4 (11 decks)

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