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NUR 195 > Leukemia/Lymphoma and Bleeding Disorders > Flashcards

Leukemia/Lymphoma and Bleeding Disorders Flashcards

1
Q

What does leukemia mean?

A
  • white blood
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2
Q

Myeloid leukemia originates?

A
  • in the bone marrow
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3
Q

Lymphoid leukemia orginates?

A
  • in the lymphatic tissue
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4
Q

acute means?

A
  • sudden onset: death can occur rapidly.

* BE AGGRESSIVE with treatment.

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5
Q

chronic means?

A
  • developed over the years: the patient can live for years development is slow.
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6
Q

Leukemia is when WBC’s accumulate in the tissue where they originate until there is no more room, and then they?

A
  • spill out lymphocytes into the lymphatic tissue
  • spill out granulocytes into the bone marrow.
  • *this crowds out other cell such as RBCs and platelets,
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7
Q

Name this leukemia:

  • affects all ages
  • > 65yrs poor prognosis
  • most common nonlymphocytic leukemia
  • induction therapy > consolidation tx
A
  • acute myeloid leukemia
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8
Q

Name this leukemia:

  • most common in children to 15yrs
  • chemo tx
A
  • acute lymphocytic leukemia
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9
Q

Name this leukemia:

  • median onset varies with race
  • caucasian 75yrs; af. american 40-75yrs
  • 5yr survival rate is 80%
  • oral chemo; leukapheresis; stem cell transplant
A
  • chronic myeloid leukemia
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10
Q

Name this leukemia:

  • 81% of patients >60yrs
  • most common form of leukemia
  • 2-20yr survival rate
  • no treatment at first; later chemo
A
  • chronic lymphocytic leukemia
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11
Q

What are the different types of lymphoma?

A
  • hodgkins

- nonhodgkins

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12
Q

Which lymphoma is this:

  • originates in single node
  • affect men > women
  • 2 peaks of onset: 20yr and after 50yr
  • chemo tx/radiation tx
A
  • hodgkins
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13
Q

Which lymphoma is this:

  • more common/more fatal
  • 50 to 60 yrs
  • chemo tx/radiation tx
A
  • nonhodgkins
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14
Q

What is the pathophysiology for non-hodgkins lymphoma?

A
  • uncontrolled proliferation of B lymphocytes
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15
Q

Which lymphoma has the presence of Reed-Sternberg cell - fragments of Epstein-Barr virus have been found in RS cell.

A
  • hodgkins
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16
Q

What are neoplasms of lymphoid tissue, usually begin in one lymph node, then spread throughout the lymphatic system and into organs?

A

lymphoma

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17
Q

What are these manifestations of?

  • anemia, pallor, dyspnea d/t decreased RBC’s
  • ecchymoses d/t decreased platelets
  • infections d/t WBC’s
  • bone pain d/t expansion of marrow
  • lymphadenopathy
  • hepatomegaly or splenomegaly
  • abdominal pain, weight loss, nausea, fatigue, anorexia
A

leukemia

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18
Q

What are these manifestations of?

  • painless progressive enlargement of lymph nodes, spleen, lymphoid tissues.
  • cervical lymph node is usually the 1st
  • night sweats, sweating, fever, itching, weight loss
A

Hodgkins

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19
Q

What are these manifestations of?

- may find location of tumor I/e abdominal or pelvic mass.

A

non-hodgkins

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20
Q

What are the diagnostics for leukemia?

A
  • CBC
  • bone marrow biopsy
  • CSF analysis
21
Q

What are the diagnostics for lymphoma?

A
  • lymph node biopsy

- CT image of lymph nodes

22
Q

How long are you NPO for a CT if contrast is being used? How many hours prior to the Ct is contrast given?
What should you encourage after a CT?
What should you monitor after Ct?

A
  • at least 8 hours
  • 1-2 hrs
  • fluids
  • monitor BM’s
23
Q

Treatment for leukemia & lymphoma is?

A
  • chemo/radiation
  • platelets to prevent bleeding
  • PRBC’s to prevent anemia and resulting activity intolerance
  • VTE prophylaxis if hospitalized
24
Q

What do you monitor when getting PRBC’s?

A
  • CBC: Hgb/Hct
25
Q

When caring for a patient with leukemia/lymphoma assess for?

A
  • infection
  • bleeding
  • anemia
  • daily weights
  • activity intolerance
  • fall risks
  • coping skills
  • pain management
  • daily intake and output
  • monitor diet
  • CAREFUL NERUO ASSESSMENT**
26
Q

Teach patients with leukemia and lymphoma:

A
  • what to expect with each diagnostic
  • medications and what they do along with adverse effects
  • danger signs to report FEVER
  • how to monitor for bleeding
  • to use stool softener and soft toothbrushes
  • blood in urine
  • coffee-ground emesis
27
Q

What is it called when your body has deficient number of circulating platelets?

A
  • Thrombocytopenia
28
Q

What is a complication of thrombocytopenia?

A
  • hemorrhage
29
Q

What disease is hereditary deficiency of vWF coal protein and platelet dysfunction and Factor VIII deficiency?

A
  • vonWillebrand’s Disease

- also known as pseudohemophilia

30
Q

What is it called when your body has a deficiency of platelets that occurs when the immune system destroys the body own platelets?

A
  • immune thrombocytopenic purpura (ITP)
31
Q

What is the most common cause of hemorrhagic d/o?

A
  • Thrombocytopenia
32
Q

What are the four mechanisms that could be responsible for thrombocytopenia?

A
  • decreased platelet production
  • decreased platelet survival
  • pooling of blood in the spleen
  • intravascular dilation of circulating platelets
33
Q

What are common causes of thrombocytopenia?

A
  • defective platelet production in the bone marrow
  • increased platelet destruction outside the bone marrow
    EX: cirrhosis, DIC, severe infection or sepsis
34
Q

Massive blood loss from trauma treated with fluid resuscitation can cause?

A

dilution thrombocytopenia

35
Q

What are some drugs that can cause thrombocytopenia?

A
  • ReoPro
  • cordarone
  • ampicillin
  • Tegretol
  • gold salts
  • heparin
  • ibuprofen
  • naproxen (NSAIDS)
  • dilantin
  • zosyn
  • duinine
  • zantac
  • rifampin
  • zocor
  • Bactrim
  • vancomycin
36
Q

Can congenital or acquired viral infections cause thrombocytopenia?

A
  • YES
37
Q

Can hypersplenism and hypothermia cause thrombocytopenia?

A
  • YES
38
Q

Risk factors for thrombocytopenia:

A
  • leukemia
  • aplastic anemia
  • HIV
  • hep C
  • Epstein-Barr
  • rubella
  • mumps
  • varicella
  • bacterial infection
  • sepsis
  • coagulopathy problems
  • pregnancy
  • malignancy
  • rheumatologic/autoimmune d/o
  • ETOH abuse
39
Q

What is the most common type of bleeding d/o?

A
  • vonWillebrands Disease
40
Q

What are the common causes of vonWillebrands disorder?

A
  • acquired cancer
  • non-hodgkins
  • leukemia
  • drugs
  • immune d/o (ex: lupus)
  • it can also be inherted*
41
Q

Normal platelets last ___ to ____ days but in ITP ____ to ____ days or less.

A
  • 7 to 10

- 1 to 3

42
Q

With ITP that is caused by acute virus prognosis is?

A
  • excellent
43
Q

With ITP that is caused by chronic essential or autoimmune disorders prognosis is?

A
  • good remission lasts weeks to years.
44
Q 
What do these manifestations represent?
- sudden onset perechiae/ecchymoses
- bleeding from mucous membranes
- fatigue/malaise
- general weakness
- menorrhagia
- splenomegaly
LABS:
plts: <140,000
prolonged PT; aPTT is normal or increased
A
  • Thrombocytopenia
45
Q 
What do these manifestations represent?
- ecchymoses
- neuro signs: pain, lack of sensation in limb
- paralysis
- epistaxis
- hemarthrosis or joint deformities
LABS: 
NL plt count
aPTT increased
Factor VIII absent or reduced
A
  • vonWillebrands
46
Q 
What do these manifestations represent?
- epistaxis
- mennorhagia
- prolonged bleeding
-petechiae/ecchymoses 
- bleeding from mucous membranes
- absence of splenomegaly 
LABS:
plt count is <75,000
NL PT and PTT
A
  • ITP
47
Q

What can you administer to a patient with von willebrands for dental procedures that is short acting?

A
  • DDAVP: its a nasal spray that will increase factor VIII or vWF
48
Q

What treatment is used for ITP?

A
  • prednisone and if the patient is unresponsive to prednisone then IV immune globulin
  • if all medication therapy fails splenectomy surgery

NUR 195 (13 decks)

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