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PNI > Leukemia > Flashcards

Leukemia Flashcards

1
Q

what is leukemia

A

malignant neoplasm of blood forming organs

*high incidence in kids

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2
Q

leukemia is characterized by

A

an abnormal overproduction of immature forms of any of the leukocytes

  • interference with normal blood production
  • leads to decreased RBC and platelets
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3
Q

four problems r/t leukemia

A

1) anemia results d/t decreased RBC and blood loss
2) immunosuppression d/t increased # immature WBC (profound neutropenia)
3) hemorrhage d/t thrombocytopenia (low platelet ct)
4) invasion of other organs (liver, spleen, lymph, kidneys, lungs, and brain)

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4
Q

normal RBC

A

4-5/6 million mcL

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5
Q

normal WBC

A

4500-11000

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6
Q

normal platelets

A

150,000-450,000

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7
Q

diagnosis of leukemia

A
  • biopsy
  • bone marrow aspiration
  • lumbar puncture
  • frequent blood cts
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8
Q

general treatment of leukemia

A

antineoplastic chemo

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9
Q

causes of leukemia

A
  • genetics
  • ionizing radiation
  • viral infections (human T cells)
  • chemicals/drugs
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10
Q

-inability of leukocytes to mature (those that do are abnormal)
-occurs at any time during life cycle
onset is insidious

A

Acute Myelogenous Leukemia (AML)

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11
Q

prognosis for AML

A
  • POOR prognosis
  • 5 yr survival is 20%
  • 50%n survival for kids
  • cause of death tends to be d/t overwhelming infection
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12
Q
  • abnormal production of granulocytic cells
  • biphasic disease
  • young to middle aged adults
A

Chronic Myelogenous Leukemia (CML)

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13
Q

prognosis for CML

A
  • Poor prognosis
  • 5 yr survival is 37%
    cause: ionizing radiation , chemicals
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14
Q

CML stages

A

chronic stage is about 3 yrs

acute phase is about 2-3 mos

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15
Q
  • abnormal leukocytes found in blood forming tissue

* most common in children (most common kid cancer)

A

acute lymphocytic leukemia (ALL)

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16
Q

prognosis for ALL

A

GOOD

>5 yr prognosis is 80%

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17
Q
  • increased production of leukocytes and lymphocytes and proliferation of cells within bone marrow, spleen, liver
  • occurs after age 35 (older adults)
A

chronic lymphocytic leukemia (CLL)

18
Q

prognosis for CLL

A

GOOD

5 yr survival is 75%

19
Q

important to remember about CLL

A

often asymptomatic and NOT treated

20
Q

treatment of CML

A
  • conservative, oral antineoplastic agents
  • (Hydrea) Hydroxyurea- DNA synthesis inhibitor
  • Interferon (unknown)
  • (Gleevec) Imatinib mesylate- if cells are philadelphia chromosome positive
21
Q

leukemia nursing assessment

A
  • tendency to bleed ( petechia, nosebleeds, bleeding gums, ecchymoses, nonhealing skin abrasions)
  • anemia (fatigue, pallor, headache, bone/joint pain, hepatosplenomegaly)
  • infection: fever, tachycardia, lymphadinopathy (swollen lymph nodes), night sweats, skin infections)
  • GI distress: anorexia, abd pain, wt loss, sore throat, diarrhea
22
Q

in an immunosupressed person, infection manifests as _____

A

increased temp

  • lower parametes (ie/ report if > 38.05 or 100.49)
  • do thorough assessment frequently
23
Q

what is a salicylate

A

aspirin

24
Q

most oncologic drugs cause _______

A
  • immunosupression
  • prevent secondary infections
  • stay away from people with colds
  • private room
  • sterile/clean environment
  • no RAW veggies/fruits, ensure cooked
25
Q

interventions if immunosuppressed

A
  • monitor WBC daily
  • assess oral cavity and genitals for yeast
  • monitor VS frequently
  • administer abx
  • teach/enforce infection control
  • oral hygiene regimen
  • encourage coughing and deep breathing
  • AVOID rectal temp
  • monitor fluids (encourgae 3L/day)
  • encourage mobility
  • assess for bleeding, NO salicylates
26
Q

what should the oral hygeine regimen entail

A
  • soft toothbrush
  • no salt and soda
  • water soluble lubricant for lips
  • NO lemonglycerin swabs
27
Q

what to remember about abx

A

-notify HCP if delay in admin
trough (before admin)
peak (30 min to 1 hr after admin)

28
Q

this is toxic to cancer AND normal cells of both client and caregiver infusing

A

antineoplastic chemo

29
Q

who may be prohibited from administering chemo

A

if pregnant or wanting to become pregnant

30
Q

precautions with antineoplastic chemo drugs

A
  • wear gloves when handling drugs

- check drug with another nurse to ensure prescription correck

31
Q

if IV cath line used for infusion…

A

verify line placement and patency with another nurse and aspirate for blood return

32
Q

if vesicant drug is administered peripherally…

A
  • stay with pt and check IV placement and patency frequently, aspirate for blood return
  • use new side DAILY (dispose in specifically provided waste receptacle)
33
Q

extrapyramidal s/s

A

(d/t antipsychotic meds)

  • acute dyskinesia
  • parkinsonism
  • akinesia
  • akathisia
  • tardive dyskinesia
  • dystonic reactions
  • neuroleptic malignant syndrome
34
Q

describe ondasetron HCl

A

*zofran
-prevent or relieve N/V
SE: headache (give analgesic)

35
Q

how is ondasetron administered

A

30 min before chemo
1-2 hr before radiation
*dilute IV injection in 50 mL NaCl

36
Q

describe granisetron

A

-relieve N/V

SE: HTN, CNS stimulation, increased LE

37
Q

assess for what if on granisetron

A
  • extrapyramidal S/S
  • monitor liver enzymes
  • give only on day of chemo/radiation, 1 hr before
38
Q

describe prochlorperazine and promethazine HCl

A

-N/V

SE: drowsiness, dizziness, EP, blurry vision, dry mouth, orthostatic hypotesion

39
Q

how to administer prochlorperazine and promethazine HCl

A
  • dilute if oral solution with juice
  • determine Baseline BP before
  • give deep IM
  • monitor BP
40
Q

describe metoclopramide HCl, Haloperidol, Diaphenhydramine

A
  • N/V

- SE: drowsiness, restlessness, fatigue, EP

41
Q

what to assess for metoclopramide HCl, Haloperidol, Diaphenhydramine

A
  • caution of decreased alertness
  • avoid alcohol
  • discontinue if EP s/s occur

PNI (11 decks)

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