Leukemia & Lymphoma

Question 1

MDS

Answer 1

pre-leukemic disorder

Question 2

MDS interventions

Answer 2

pancytopenia support, cure w stem cell transplant

Question 3

course of treatment for leukemia

Answer 3

induction - intense chemo @ dx
continue treating to cure & maintain remission

Question 4

conditioning for STC

Answer 4

intense chemo/rad given to wipe out pt bone marrow

Question 5

why is conditioning important?

Answer 5

helps ensure successful engraftment

Question 6

side effects of transplantation - STC

Answer 6

fever, hypotension or hypertension w HF

Question 7

premedication for STC

Answer 7

diphenhydramine, acetaminophen, hydrocortisone
antiHTN & diuretics PRN

Question 8

when should labs rise after engraftment

Answer 8

2-3 weeks

Question 9

chimerism

Answer 9

GOOD - means donor cells not pt cells

Question 10

progressive chimerism

Answer 10

GOOD - more donor cells, successful engraftment

Question 11

regressive chimerism

Answer 11

BAD - more pt cells, graft failure

Question 12

complications of STC

Answer 12

GVHD, failure to engraft, infection, pancytopenia, SOS

Question 13

causes of graft failure

Answer 13

not enough cells transplanted, infection of donor cells, immune response to donor cells

Question 14

GVHD

Answer 14

donor cells attack pt cells

Question 15

GVHD s/s

Answer 15

dry eyes, dry peely skin, diarrhea

Question 16

SOS

Answer 16

blockage of liver blood vessels from clotting/inflammation

Question 17

s/s of SOS

Answer 17

jaundice, RUQ pain, ascites, weight gain

Question 18

SOS tx

Answer 18

supportive - manage FVO s/s, allopurinol for kidney stones, monitor LFT

Question 19

s/s of reduced platelet function

Answer 19

nosebleeds, bruise easily, bleeding from gums, hematuria, melena, petechiae

Question 20

CV s/s of leukemia

Answer 20

d/t anemia - tachycardic, palpitations

Question 21

resp s/s of leukemia

Answer 21

d/t anemia - tachypneic, may have pneumonia (bc neutropenia)

Question 22

skin s/s of leukemia

Answer 22

infections, pale/cold, petechiae, bleeding gums, lesions

Question 23

GI s/s of leukemia

Answer 23

weight loss, n/v, anorexia, constipation

Question 24

neuro s/s of leukemia

Answer 24

seizure, headache (could be bleed)

Question 25

expected labs w leukemia

Answer 25

pancytopenia, low PT & INR

Question 26

vax considerations w leukemia

Answer 26

pt & fam - no live virus for 2 yrs after STC; pt - no vax for 1st year

Question 27

infection prevention - leukemia

Answer 27

prophylactic antimicrobials, mask, keep central aseptic, no standing water, auscultate lung sounds, keep skin clean & dry, no HAPIs, neutropenic precautions

Question 28

s/s of infection w neutropenic pts

Answer 28

low grade temp

Question 29

protocol for sus. infection in neutropenic

Answer 29

cultures –> ABX
chest x-ray

Question 30

monitor what for thrombocytopenia

Answer 30

stool, urine, drainage, emesis, abd girth

Question 31

bleeding prevention

Answer 31

avoid sharp objects, soft toothbrush, electric razor, no anticoag, prevent straining, avoid anything that increases ICP, report bad headaches

Question 32

central line care

Answer 32

flush daily, before & after infusion; teach s/s of infection, occlusive dressing, change cap weekly

Question 32

Hodgkin’s lymphoma s/s

Answer 32

enlarged, painless lymph nodes, night sweats, fever, weight loss

Question 33

Hodgkin’s dx

Answer 33

biopsy for Reed-Sternberg cells, other tests/scans to stage

Question 34

non-Hodgkin’s

Answer 34

slow progressing

Question 35

complications of pts receiving tx for lymphoma

Answer 35

pancytopenia, n/v, constipation/diarrhea, sterility, secondary cancer, skin issues w rad

Question 36

rituximab

Answer 36

monoclonal antibody - NHL tx