Module 1 Exam 1- Blood oncology Flashcards
leukemia
cancer of blood cells and blood forming organs; immature blast cells that cant mature and lose ability to stop division leading to taking over bone marrow, nutrients, growth factors, and drains resources; usually leukocytes
types of leukemia’s
acute myeloid leukemia, chronic myeloid leukemia, acute lymphocytic leukemia, chronic lymphocytic leukemia
patho of acute myeloid leukemia (AML)
defect in stem cell that differentiates into myeloid cells: monocytes, granulocytes, erythrocytes, and platelets; affects entire myeloid branch; peak incidence in 60s
manifestations of acute myelod leukemia (AML)
fever, infection, weakness, fatigue, pain from enlarged spleen/liver, bleeding, bone pain, hyperplasia of gums
treatment of AML
chemo, stem cell therapy, supportive therapy, antibiotics
prognosis of AML
death occurs in months
patho of chronic myeloid leukemia
philadelphia cells, mutation in myeloid stem cells causing uncontrolled proliferation, failure of B cell
stages of chronic myeloid leukemia (CML)
chronic, transformational, blast crisis
blast crisis
when immature cells cannot mature or fight off infections
manifestations of chronic myeloid leukemia (CML)
initially asymptomatic, malaise, anorexia, unexplained weight loss, confusion, SOB, enlarged liver or spleen
treatment of chronic myeloid leukemia
blocks signals in leukemic cells that express BCR-ABL protein; chemotherapy; HSCT
patho of acute lymphocytic leukemia (ALL)
uncontrolled proliferation of immature cells from lymphoid stem cells; affects lymphoid branch (T cells and B cells); affects young children; peaks at 4yrs; boys more affected
manifestations of acute lymphocytic leukemia (ALL)
pain reaulting from enlarged liver/spleen, bone pain, CNS is affected, headache, vomiting
treatment of acute lymphocytic leukemia (ALL)
chemotherapy, stem cell transplant, supportive therapy, monoclonal antibodies
prognosis of acute lymphocytic leukemia (ALL)
85% of pt live for 3 years event free, drops with increased age <45% adults
patho of chronic lymphocytic leukemia
need to assess for hx of leukemia
manifestations of chronic lymphocytic leukemia (CLL)
slow, bleeding, anemia, weakness, fatigue, lymphadenopathy
chronic lymphocytic leukemia (CLL) lab tests
leukocyte count, ANC, Hct, Plt, BUN/Cr, electrolytes, coags, LFT’s, cultures and sensitivity
multiple myeloma patho
plasma cell cancer of B lymphocyte and create tons of antibodies; bone marrow is crowded by B cells; skeleton tumors formed from malignant plasma cells that penetrate bone marrow and form tumors; antibodies released cannot be filtered out by kidney and cause AKI; hypercalcemia due to calcium being released from overcrowding of bone marrow from antibodies
signs and symptoms of multiple myeloma
bone pain in spine and chest specifically, pain and numbness in legs, fatigue, weight loss, osteoporosis, bone fractures, renal impairment
complications associated with multiple myeloma
infection, brittle bones, anemia (chronic), kidney failure/AKI, hypercalcemia
Treatment of multiple myeloma
HSCT, chemotherapy, bisphosphonates/alendronate, radiation; MM is rarely cured but can relieve pain
HSCT
hematopoietic stem cell transplant
lymphoma
neoplasm of lymphoid origin; hodkins lymphoma and non-hodkins lymphoma
hodgkins lymphoma
single node, reed sternberg cell (multiple nucleus); epstein barr virus; gentic (20s and 50s); environmental
non-hodgkins lymphoma
lymph tissue infiltrated with malignant cells; lymphadenopathy; chromosomal translocations; infections; environmental; AIDS chemotherapy; radiation
clinical manifestations of lymphoma
immobile swollen lymph nodes can be present in axilla, neck, groin; weight loss; fever; night sweats
treatment of lymphomas
chemotherapy, radiation, HSCT, NHL- immunotherapy; bone marrow transplant
types of blood transfusions
RBCs or PRBCs, whole blood, platelets, FFP, Cryoprecipitate (Cryo)
prior to a blood transfusion…
type and cross match blood, explain procedure, obtain informed consent (need written), adequate IV access with atleast 20 gauge, hospitla policy and procedure for blood transfusions (IV pump), must remain with patient for 15 min following transfusion and monitor vitals
patients who cannot receive blood transfusions
jehova witness; can do autologous procedure to remove own blood overtime and give blood back during procedure; can receive albumin to expand blood
types of blood cells
A-, A+, B-, B+, AB-, AB+, O-, O+
Complications of transufions
febrile, non-hemolytic reactions; hemolytic transfusion reaction (stop immediately); ABO incompatibility which is life threatening (STOP immediately); Rh incompatibility; Circulatory overload; septicemia; hyperkalemia; iron overload
febrile non-hemolytic reaction
caused by platelet antigen or leukocyte sensitivity; causes temp to rise, chills, headache, flushing, anxiety during or soon after transfusion; most common reaction; can premedicate with benadryl and antipyretics
acute hemolytic reaction
hot feeling along the vein during transfusion; fever, chills, jaundice, flank pain, constricting pain in chest, low back pain, headache, nausea, tachycardia, tachypnea, hypotension, hemoglobinuria, impending doom feeling; correlation between amount of blood transfused and chances of fatal reaction (>100mL is increased chance of fatality)
nursing management of acute hemolytic reaction
STOP immediately; maintain patent IV with NS; monitor/ maintain airway, VS, and U/O; urine analysis for Hgb determination; notify provider and blood bank; save blood, supplies, and labels to return to blood bank; fill out transfusion reaction form; follow hospital procedure
diseases that can be transfused via blood
most common is hepatitis B and C; HIV and HTLV; CMV (highest risk for newborns/preemies)
circulatory overload transfusion reaction
infusion rate of transfusion is too fats or too much volume given
signs and symptoms of circulatory overload from transfusion; common in pt with HF; admin with diuretic because pt needs blood
cough, dyspnea, chest pain, rales, pulmonary edema, headache, HTN, tachycardia, rapid bounding pulse, distended neck veins
nursing interventions for reaction overload
decrease rate of infusion, position upright with feet dependent, admin O2 and diuretics as ordered; if pt at risk then admin diuretics between units
septicemia from transufions
occurs with transfusion of blood contaminated with microorganisms
signs and symptoms of septicemia from blood transfusion
rapid onset of chills and high fever, vomiting, diarrhea, tachycardia, hypotension/shock
nursing interventions for suspected septicemia from blood transfusion
obtain blood cultures and cultures of blood bag; admin IV fluids, antibx, steroids, vasopressor
iron overload aka chelation from blood transfusion
patients receive too many units of PRBC over short period of time; can cause cardiac or endocrine failure
signs and symptoms of iron overload (chelation)
vomiting, diarrhea, hypotension
nursing interventions for iron overload
administer deferoxamine (desferal) IV or SQ to remove excess iron through the kidneys; urine will turn red and know to discontinue when urine returns to normal color
hyperkalemia from blood transfusions
RBCs are lysed and release potassium; stored blood releases potassium via hemolysis; the older the blood the greater chance of increasing potassium; check dates on units of blood; check serum potassium pre and post transfusion
anemia
lower than normal Hgb and fewer circulating RBCs (erythrocytes)
microcytic anemia
smaller than normal mean corpuscular volume; decrease RBC production; iron deficiency Iron holds RBC together); MCV < 80; pale RBC
macrocytic anemia
megaloblastic: vitamin B12 and folate deficiency; non-megaloblastic: alcohol; MCV > 100
classic signs of anemia
pallor, fatigue, dyspnea on exertion (DOE), dizziness
anemia magnitudes
Hgb < 8 likely to be symptomatic; Hgb > 12 less likely to be symptomatic
Assessment of patient with anemia
Health history/Physical exam: neuro, cardiac, GI, blood loss?; Labs: CBC (H&H), iron, ferritin; Nutritional assessment; Medications
nursing interventions for anemia
balance physical activity and rest to decrease fatigue; adequate nutrition and hydration to maintain nutrition; compliance with medications like iron; monitor VS and maintain adequate perfusion; supportive therapy with O2 and fluids; monitor for complications like HF, angina, parasthesia, confusion
do not take iron with…
calcium
do take iron with…
fruit juice, multivitamin, vitamin C, and take on empty stomach
medical management of anemia
correct cause with specific treatment; transfuse PRBCs; increase vitamin B12, folate, and iron; immunosuppression therapy; supportive therapy for sickle cell with steroids and immunosuppression
meds for iron deficient anemia
PO- ferrous sulfate, ferrous gluconate, ferrous fumarate; if PO iron poorly absorbed the IV iron
sickle cell anemia
hemolytic anemia; shortened life of RBC due to hemolysis; sickle cell shaped that can block arteries and cause pain; cell sickles d/t giving up O2 and gets stuck in capillaries and does not allow O2 to pass
Signs and symptoms of sickle cell anemia
s shaped Hgb; pain crisis with cold, infection, dehydration
sickle cell anemia complications
stroke, hypoxia-ischemia, dehydration, myocardial infarction, kidney disease, substance abuse, heart failure
how to treat sickle cell anemia
infection prevention, PRBCs, hydration, treat pain with NSAIDs then opioids, O2 therapy, increase fluids, prevent fatigue, admin hydroxyurea as immunotherapy suppressant
thrombocytopenia
deficient platelet count; arises from medications or bone marrow suppression; leads to bleeding into tissues and slow clotting
causes of thrombocytopenia
decreased production or platelets; increased destruction of platelets; increased consumption of platelets; cancer like immature leukocytes that crown bone marrow; all coag factors are normal
signs and symptoms of thrombocytopenia
bleeding, petechiae, ecchymosis, epistaxis, bleeding gums, purpura (pin point cots)
complications associated with thrombocytopenia
hemorrhage and heparin induced thrombocytopenia
treatment for thrombocytopenia
corticosteroids, folate, IvIG, splenectomy, platelet transfusion
heparin induced thrombocytopenia
fall in platelet count and increased clot risk
treatment of heparin induced thrombocytopenia
stop the heparain; switch to a different anticoagulant
virchows triad
hypercoagulable state composed of being pregnant or COPD, venous stasis, endothelial damage from HTN or diabetes
chronic anemia can lead to…
chronic kidney disease
disseminated intravascular coagulation (DIC)
a symptom not a disease; altered hemostasis mechanism; consists of massive clotting then clotting factors are consumed leading to massive bleeding
tirggers for DIC
sepsis, trauma, shock, ARDS, cancer, toxins, allergic reactions
assessment of individual with DIC
bleeding s/s- petechiae, hematuria, melena, epistaxis; thrombi; diagnostic panel looks at Plt, fibrinogen, Pt/PTT, INR, D-dimer
d-dimer lab test
helps determine if clot is present in body somewhere
how to treat DIC
treat underlying cause; correct tissue ischemia; maintain hemodynamic status like BP with vasopressors; replace fluid and electrolyte, clotting factors, pRBCs; use heparin or LMWH
complications with DIC
AKI, PE, stroke, hemorrhage, ARDS
Neutropenia
decreased production or destruction of neutrophils; severe <500; neutrophils are the WBC that respond first to area of injury or infection; ANC is absolute neutrophil count
complications of neutropenia
increased risk for infection
what to avoid in neutropenia
fresh flowers, fresh/raw vegetables, undercooked meat, standing water, large crowds
what to wear when encountering neutropenic conditions
surgical gown, gloves, mask
ANC
absolute neutrophil count; less than 500 is severe
compensatory mechanisms of anemia
tachycardia, vasoconstriction, palpitations, tachypnea, fluid increase via RAAS
pernicious anemia
autoimmune disorder where body cannot absorb vitamin b12; need b12 supplement for life
warfarin/coumadin antidote
vitamin k
blood used for emergencies
O- is the universal donor
RBC-PRBCs use
severe anemia; only when pt lacking RBCs
Whole blood uses
hypovolemic shock or during hemorrhage
platelet transfusion use
thrombocytopenia
Fresh frozen plasma transfusion uses
when need to increase clotting factors or volume expansion; often given with RBCs to increase fluids
uses for cryoprecipitate transfusion
concentrated form of clotting factors usually given for DIC;
clotting factors like VII/XIII von willebrand factor, dont need compatibility testing, hemophilia, vWB disease,
blood components
RBCs - 45%; WBCs < 1%; Platelets < 1%; Plasma - 55%; 2 million RBCs created per minute; 4 million platelets created per minute; 100,000 WBCs created per minute
when admin blood…
label and compare to blood type as listed on medical record; double nurse witness for right blood and right patient; speak outloud
When hanging blood following confirmation with another nurse…
prime tubing with NS; VS prior, 15 min, infusion comleted; infuse over 3-4 hours
preop phase
decision is made and ends with patient on OR bed
preop assessment
health history and physical exam (review of systems and vitals), medications, allergies, drugs or alcohol consumption, nutritional and fluid status, labs
informed consent from preop
nurse is a witness; should be written, nurse can clarify what was stated by surgeon; invalid signature if pt on psychoactive meds
preop pt teaching
deep breathing, incentive spirometer, coughing; mobility, active body movement; pain management; cognitive coping strat.; instructions for pt undergoing ambulatory surgery
expected outcomes from preop teaching
relieve anxiety, decrease fear, understand surgical intervention, no evidence of complications
