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Adults 2 > Module 1 Exam 1- Blood oncology > Flashcards

Module 1 Exam 1- Blood oncology Flashcards

1
Q

leukemia

A

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

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2
Q

types of leukemia’s

A

acute myeloid leukemia, chronic myeloid leukemia, acute lymphocytic leukemia, chronic lymphocytic leukemia

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3
Q

patho of acute myeloid leukemia (AML)

A

defect in stem cell that differentiates into myeloid cells: monocytes, granulocytes, erythrocytes, and platelets; affects entire myeloid branch; peak incidence in 60s

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4
Q

manifestations of acute myelod leukemia (AML)

A

fever, infection, weakness, fatigue, pain from enlarged spleen/liver, bleeding, bone pain, hyperplasia of gums

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5
Q

treatment of AML

A

chemo, stem cell therapy, supportive therapy, antibiotics

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6
Q

prognosis of AML

A

death occurs in months

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7
Q

patho of chronic myeloid leukemia

A

philadelphia cells, mutation in myeloid stem cells causing uncontrolled proliferation, failure of B cell

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8
Q

stages of chronic myeloid leukemia (CML)

A

chronic, transformational, blast crisis

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9
Q

blast crisis

A

when immature cells cannot mature or fight off infections

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10
Q

manifestations of chronic myeloid leukemia (CML)

A

initially asymptomatic, malaise, anorexia, unexplained weight loss, confusion, SOB, enlarged liver or spleen

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11
Q

treatment of chronic myeloid leukemia

A

blocks signals in leukemic cells that express BCR-ABL protein; chemotherapy; HSCT

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12
Q

patho of acute lymphocytic leukemia (ALL)

A

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

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13
Q

manifestations of acute lymphocytic leukemia (ALL)

A

pain reaulting from enlarged liver/spleen, bone pain, CNS is affected, headache, vomiting

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14
Q

treatment of acute lymphocytic leukemia (ALL)

A

chemotherapy, stem cell transplant, supportive therapy, monoclonal antibodies

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15
Q

prognosis of acute lymphocytic leukemia (ALL)

A

85% of pt live for 3 years event free, drops with increased age <45% adults

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16
Q

patho of chronic lymphocytic leukemia

A

need to assess for hx of leukemia

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17
Q

manifestations of chronic lymphocytic leukemia (CLL)

A

slow, bleeding, anemia, weakness, fatigue, lymphadenopathy

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18
Q

chronic lymphocytic leukemia (CLL) lab tests

A

leukocyte count, ANC, Hct, Plt, BUN/Cr, electrolytes, coags, LFT’s, cultures and sensitivity

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19
Q

multiple myeloma patho

A

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

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20
Q

signs and symptoms of multiple myeloma

A

bone pain in spine and chest specifically, pain and numbness in legs, fatigue, weight loss, osteoporosis, bone fractures, renal impairment

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21
Q

complications associated with multiple myeloma

A

infection, brittle bones, anemia (chronic), kidney failure/AKI, hypercalcemia

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22
Q

Treatment of multiple myeloma

A

HSCT, chemotherapy, bisphosphonates/alendronate, radiation; MM is rarely cured but can relieve pain

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23
Q

HSCT

A

hematopoietic stem cell transplant

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24
Q

lymphoma

A

neoplasm of lymphoid origin; hodkins lymphoma and non-hodkins lymphoma

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25
Q

hodgkins lymphoma

A

single node, reed sternberg cell (multiple nucleus); epstein barr virus; gentic (20s and 50s); environmental

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26
Q

non-hodgkins lymphoma

A

lymph tissue infiltrated with malignant cells; lymphadenopathy; chromosomal translocations; infections; environmental; AIDS chemotherapy; radiation

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27
Q

clinical manifestations of lymphoma

A

immobile swollen lymph nodes can be present in axilla, neck, groin; weight loss; fever; night sweats

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28
Q

treatment of lymphomas

A

chemotherapy, radiation, HSCT, NHL- immunotherapy; bone marrow transplant

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29
Q

types of blood transfusions

A

RBCs or PRBCs, whole blood, platelets, FFP, Cryoprecipitate (Cryo)

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30
Q

prior to a blood transfusion…

A

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

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31
Q

patients who cannot receive blood transfusions

A

jehova witness; can do autologous procedure to remove own blood overtime and give blood back during procedure; can receive albumin to expand blood

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32
Q

types of blood cells

A

A-, A+, B-, B+, AB-, AB+, O-, O+

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33
Q

Complications of transufions

A

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

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34
Q

febrile non-hemolytic reaction

A

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

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35
Q

acute hemolytic reaction

A

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)

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36
Q

nursing management of acute hemolytic reaction

A

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

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37
Q

diseases that can be transfused via blood

A

most common is hepatitis B and C; HIV and HTLV; CMV (highest risk for newborns/preemies)

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38
Q

circulatory overload transfusion reaction

A

infusion rate of transfusion is too fats or too much volume given

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39
Q

signs and symptoms of circulatory overload from transfusion; common in pt with HF; admin with diuretic because pt needs blood

A

cough, dyspnea, chest pain, rales, pulmonary edema, headache, HTN, tachycardia, rapid bounding pulse, distended neck veins

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40
Q

nursing interventions for reaction overload

A

decrease rate of infusion, position upright with feet dependent, admin O2 and diuretics as ordered; if pt at risk then admin diuretics between units

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41
Q

septicemia from transufions

A

occurs with transfusion of blood contaminated with microorganisms

42
Q

signs and symptoms of septicemia from blood transfusion

A

rapid onset of chills and high fever, vomiting, diarrhea, tachycardia, hypotension/shock

43
Q

nursing interventions for suspected septicemia from blood transfusion

A

obtain blood cultures and cultures of blood bag; admin IV fluids, antibx, steroids, vasopressor

44
Q

iron overload aka chelation from blood transfusion

A

patients receive too many units of PRBC over short period of time; can cause cardiac or endocrine failure

45
Q
A
45
Q

signs and symptoms of iron overload (chelation)

A

vomiting, diarrhea, hypotension

46
Q
A
47
Q

nursing interventions for iron overload

A

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

48
Q

hyperkalemia from blood transfusions

A

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

49
Q

anemia

A

lower than normal Hgb and fewer circulating RBCs (erythrocytes)

50
Q

microcytic anemia

A

smaller than normal mean corpuscular volume; decrease RBC production; iron deficiency Iron holds RBC together); MCV < 80; pale RBC

51
Q

macrocytic anemia

A

megaloblastic: vitamin B12 and folate deficiency; non-megaloblastic: alcohol; MCV > 100

52
Q

classic signs of anemia

A

pallor, fatigue, dyspnea on exertion (DOE), dizziness

53
Q

anemia magnitudes

A

Hgb < 8 likely to be symptomatic; Hgb > 12 less likely to be symptomatic

54
Q

Assessment of patient with anemia

A

Health history/Physical exam: neuro, cardiac, GI, blood loss?; Labs: CBC (H&H), iron, ferritin; Nutritional assessment; Medications

55
Q

nursing interventions for anemia

A

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

56
Q

do not take iron with…

A

calcium

57
Q

do take iron with…

A

fruit juice, multivitamin, vitamin C, and take on empty stomach

58
Q

medical management of anemia

A

correct cause with specific treatment; transfuse PRBCs; increase vitamin B12, folate, and iron; immunosuppression therapy; supportive therapy for sickle cell with steroids and immunosuppression

59
Q

meds for iron deficient anemia

A

PO- ferrous sulfate, ferrous gluconate, ferrous fumarate; if PO iron poorly absorbed the IV iron

60
Q

sickle cell anemia

A

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

61
Q

Signs and symptoms of sickle cell anemia

A

s shaped Hgb; pain crisis with cold, infection, dehydration

62
Q

sickle cell anemia complications

A

stroke, hypoxia-ischemia, dehydration, myocardial infarction, kidney disease, substance abuse, heart failure

63
Q

how to treat sickle cell anemia

A

infection prevention, PRBCs, hydration, treat pain with NSAIDs then opioids, O2 therapy, increase fluids, prevent fatigue, admin hydroxyurea as immunotherapy suppressant

64
Q

thrombocytopenia

A

deficient platelet count; arises from medications or bone marrow suppression; leads to bleeding into tissues and slow clotting

65
Q

causes of thrombocytopenia

A

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

66
Q

signs and symptoms of thrombocytopenia

A

bleeding, petechiae, ecchymosis, epistaxis, bleeding gums, purpura (pin point cots)

67
Q

complications associated with thrombocytopenia

A

hemorrhage and heparin induced thrombocytopenia

68
Q

treatment for thrombocytopenia

A

corticosteroids, folate, IvIG, splenectomy, platelet transfusion

69
Q

heparin induced thrombocytopenia

A

fall in platelet count and increased clot risk

70
Q

treatment of heparin induced thrombocytopenia

A

stop the heparain; switch to a different anticoagulant

71
Q

virchows triad

A

hypercoagulable state composed of being pregnant or COPD, venous stasis, endothelial damage from HTN or diabetes

72
Q

chronic anemia can lead to…

A

chronic kidney disease

73
Q

disseminated intravascular coagulation (DIC)

A

a symptom not a disease; altered hemostasis mechanism; consists of massive clotting then clotting factors are consumed leading to massive bleeding

74
Q

tirggers for DIC

A

sepsis, trauma, shock, ARDS, cancer, toxins, allergic reactions

75
Q

assessment of individual with DIC

A

bleeding s/s- petechiae, hematuria, melena, epistaxis; thrombi; diagnostic panel looks at Plt, fibrinogen, Pt/PTT, INR, D-dimer

76
Q

d-dimer lab test

A

helps determine if clot is present in body somewhere

77
Q

how to treat DIC

A

treat underlying cause; correct tissue ischemia; maintain hemodynamic status like BP with vasopressors; replace fluid and electrolyte, clotting factors, pRBCs; use heparin or LMWH

78
Q

complications with DIC

A

AKI, PE, stroke, hemorrhage, ARDS

79
Q

Neutropenia

A

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

80
Q

complications of neutropenia

A

increased risk for infection

81
Q

what to avoid in neutropenia

A

fresh flowers, fresh/raw vegetables, undercooked meat, standing water, large crowds

82
Q

what to wear when encountering neutropenic conditions

A

surgical gown, gloves, mask

83
Q

ANC

A

absolute neutrophil count; less than 500 is severe

84
Q

compensatory mechanisms of anemia

A

tachycardia, vasoconstriction, palpitations, tachypnea, fluid increase via RAAS

85
Q

pernicious anemia

A

autoimmune disorder where body cannot absorb vitamin b12; need b12 supplement for life

86
Q

warfarin/coumadin antidote

A

vitamin k

87
Q

blood used for emergencies

A

O- is the universal donor

88
Q

RBC-PRBCs use

A

severe anemia; only when pt lacking RBCs

89
Q

Whole blood uses

A

hypovolemic shock or during hemorrhage

90
Q

platelet transfusion use

A

thrombocytopenia

91
Q

Fresh frozen plasma transfusion uses

A

when need to increase clotting factors or volume expansion; often given with RBCs to increase fluids

92
Q

uses for cryoprecipitate transfusion

A

concentrated form of clotting factors usually given for DIC;
clotting factors like VII/XIII von willebrand factor, dont need compatibility testing, hemophilia, vWB disease,

93
Q

blood components

A

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

94
Q

when admin blood…

A

label and compare to blood type as listed on medical record; double nurse witness for right blood and right patient; speak outloud

95
Q

When hanging blood following confirmation with another nurse…

A

prime tubing with NS; VS prior, 15 min, infusion comleted; infuse over 3-4 hours

96
Q

preop phase

A

decision is made and ends with patient on OR bed

97
Q

preop assessment

A

health history and physical exam (review of systems and vitals), medications, allergies, drugs or alcohol consumption, nutritional and fluid status, labs

98
Q

informed consent from preop

A

nurse is a witness; should be written, nurse can clarify what was stated by surgeon; invalid signature if pt on psychoactive meds

99
Q

preop pt teaching

A

deep breathing, incentive spirometer, coughing; mobility, active body movement; pain management; cognitive coping strat.; instructions for pt undergoing ambulatory surgery

100
Q

expected outcomes from preop teaching

A

relieve anxiety, decrease fear, understand surgical intervention, no evidence of complications

Adults 2 (7 decks)

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