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Test 3 > Neoplastic Hematological Disorders > Flashcards

Neoplastic Hematological Disorders Flashcards

1
Q

Uncontrolled growth of abnormal cells in the body

A

Cancer

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2
Q

type of cancer that affects the blood and bone marrow

A

Leukemia

“Leuk” -white
“Emia” -condition of the blood

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3
Q

2 types of Leukemia Cancer

A
  1. Acute
  2. Chronic
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4
Q
  • RAPID replication of immature WBCs that have developed a malignancy
  • May develop symptoms within weeks
  • Without warning
A

Acute Leukemia

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5
Q
  • involves more mature WBCs
  • disease onset is more gradual, may go years without symptoms
A

Chronic Leukemia

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6
Q

1st type of Leukemia:

Myeloid leukemia (an abnormal growth of the myeloid stem cell- turns into any cell except lymphocyte) is primarily classified into 2 main types

A
  1. Acute Myeloid Leukemia (AML)
  2. Chronic Myeloid Leukemia (CML)
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7
Q

Acute Myeloid Leukemia (AML):

The S/S result from insufficient production of

A

normal BLOOD cells in bone marrow
(includes RBCs, WBCs, Platelets)

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8
Q

S/S of Acute Myeloid Leukemia (AML)

A
  • Fever and infection
  • Weakness, fatigue, dyspnea on exertion, pallor
  • Petechiae, ecchymoses (bruising), bleeding tendencies
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9
Q

What age category is affected by AML?

A

adults

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10
Q

3 Diagnostics for Acute Myeloid Leukemia (AML)

A
  1. Physicall assessment
  2. CBC
  3. Bone Marrow Biopsy **
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11
Q

What cells are found in the Bone Marrow Biopsy that are the HALLMARK to AML?

A

BLAST cells
(immature leukocytes)

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12
Q

Acute Myeloid Leukemia (AML) Physical Findings

List 4

A
  1. Abdominal Pain
  2. Bone Pain
  3. Gingival infiltration- leukemic cells in gum
  4. Leukemia cutis- leukemic cells in skin
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13
Q

How to treat Acute Myeloid Leukemia (AML)

A
  1. Chemotherapy 2 stages only
    a. Induction chemotherapy: initial phase- very agressive
    b. Consolidation chemotherapy: aims at killing remaining leukemic cells- lower doses
  2. HSCT
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14
Q
  • Medical procedure where damaged or unhealthy blood cells in a patient’s body are replaced with healthy stem cells.
  • These stem cells can come from the patient themselves or from a donor.
A

Hematopoietic stem cell transplantation (HSCT)

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15
Q

Hematopoietic

A
  • process of blood cell formation.
  • production and development of various types of blood cells (RBC, WBC, and platelets) primarily in the bone marrow.
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16
Q

What are the 3 sources for stem cells.

A
  1. bone marrow
  2. peripheral blood
  3. umbilical cord blood
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17
Q

What are the 2 main complications for HSCT

A
  1. Infection
  2. Graft-Versus-Host Disease (GVHD) **

know

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18
Q

Graft-Versus-Host Disease (GVHD) attacks 3 main organs.

A
  1. Skin
  2. GI tract
  3. Liver
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19
Q

After Acute Myeloid Leukemia (AML) treatment what are 2 major complications?

A
  1. Disseminated intravascular coagulation (DIC)
  2. Tumor lysis syndrome
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20
Q

What happens in Disseminated intravascular coagulation (DIC)

A
  • Widespread activation of the clotting process in the blood vessels
  • Excessive clotting – massive amounts of tiny clots
  • Causes organ failure from ischemia (decr blood flow)
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21
Q

Disseminated intravascular coagulation (DIC):

Once body is no longer able to clott, the patient is at risk for

A

excessive bleeding

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22
Q

What occurs in TUMOR LYSIS SYNDROME

A
  • Massive leukemic cell destruction from chemotherapy
  • Lysed cells release toxins and fluids into blood circulation
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23
Q

What 3 substances increase in Tumor Lysis Syndrome?

A
  1. uric acid
  2. potassium
  3. phosphate

when K+ increases- calcium decreases

know

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24
Q
  • Type of cancer that affects the blood and bone marrow.
  • It is characterized by the overproduction/mutation of myeloid cells- (type of WBC involved in the immune response)
A

Chronic Myeloid Leukemia (CML)

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25
Q

What is the HALLMARK genetic abnormality of Chronic Myeloid Leukemia (CML)?

A

Philadelphia (Ph+) chromosome

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26
Q

3 Clinical Manifestations for Chronic Myeloid Leukemia (CML)

A
  • Might have no symptoms
  • elevated WBC count detected on routine CBC
  • May develop into acute phase
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27
Q

Patient with extremely HIGH leukocyte counts will show

A
  • Shortness of breath
  • Enlarged, tender spleen
  • Occasional enlarged liver
  • Anorexia, weight loss
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28
Q

2 Main Medical Managements for CML

A
  • Tyrosinase Kinase Inhibitors (TKIs) -medications **
  • Hematopoietic Stem Cell Transplant (HCST)

(Treatments go in this order also- start with TKIs first)

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29
Q

What do * Tyrosinase Kinase Inhibitors (TKIs) do?

A
  • Decreased the need for stem cell transplant
  • Targets the BRC-ABL protein that causes the cancer cells to grow
  • Attacks cancer cells without harming normal cells **
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30
Q

In Chronic Myeloid Leukemia- Hematopoietic Stem Cell Transplant (HCST) treatment will only be used in patients less than ___ years of age.

A

65 years of age

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31
Q

How does effective TKI therapy impact life expectancy in Chronic Myeloid Leukemia (CML) patients?

A

Effective TKI therapy can lead to a normal life expectancy in CML patients.

32
Q

Another type of Leukemia:

  • Leukemia that involves lymphocytes, a type of WBC important for the immune system.
A

Lymphocytic Leukemia

33
Q

2 types of Lymphocytic Leukemia

A
  1. Acute Lymphocytic/Lymphoblastic Leukemia (ALL)
  2. Chronic Lymphocytic Leukemia (CLL)
34
Q

An aggressive form of leukemia that leads to an OVERPRODUCTION of lymphoblasts, which are immature lymphocytes. This interferes with the normal production of blood cells

A

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)

35
Q

Acute Lymphocytic/Lymphoblastic Leukemia (ALL) is most common form in what age group?

36
Q

Which condition increases the risk of developing Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?

A

Down Syndrome

37
Q

What is the treatment response for children with Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?

A

A: Children with ALL are very responsive to treatment.

38
Q

4 Clinical Manifestations for ALL

A
  1. WBC may be low or elevated
  2. Infiltration to other organs very common: abdomoinal pain, bone pain
  3. CNS involvement common: headache, vomiting
  4. May spread to testicles and breasts
39
Q

Medical Management for ALL that makes it different from AML

A

ALL has 3 chemo phases for medical management.
AML has only 2 chemo phases.

40
Q

List Medical Managements for ALL

4 total (including the phases)

A
  1. Chemotherapy
    -Induction Phase: Short, intensive, kill ALL leukemia
    -Consolidation Phase:
    -Maintenance phase – Less intensive; lasts for about 2 years
  2. intrathecal chemotherapy- due to CNS involvement - unique to (ALL) **
41
Q
  • Type of cancer that affects the blood and bone marrow, specifically targeting mature B lymphocytes
  • characterized by the accumulation of abnormal, mature B lymphocytes- Cells dont die
A

Chronic Lymphocytic Leukemia (CLL)

42
Q

In Chronic Lymphocytic Leukemia (CLL), cells accumulate in 2 areas.

A

lymph nodes and spleen

43
Q

5 Clinical Manifestations for CLL

A
  • Many patient are asymptomatic – CLL found during routine physical exam
  • Increased lymphocyte count
  • Enlargement of lymph nodes (lymphadenopathy)
  • Splenomegaly
  • Hepatomegaly
44
Q

3 Medical Management for CLL

A
  1. Wait and watch in early stages
  2. combined chemo-immunotherapy **
  3. Intravenous immunoglobulin (IVIG) – if having recurrent infections
45
Q

Would Stem Cell Transplant be an option for OLDER patients with CLL?

46
Q

Nursing Management for CLL

A
  1. Monitor for complications- same as acute
  2. Monitor lab results: Creatinine, Electrolyte levels, etc
  3. Report culture results immediately
  4. Bleeding precautions: soft toothbrush, use electric razor, prevent constipation, avoid sharp objects, prevent falls
  5. Neutropenic precautions- low levels of lymphocytes WBC. Important to prevent infection!!!
47
Q

A rare blood cancer characterized by the overproduction of red blood cells, which can lead to increased blood viscosity

A

Polycythemia Vera
(can also result in too many WBC or Platelets)

48
Q

S/S of Polycythemia Vera

A
  • Reddish (Ruddy) skin complexion
  • Increased blood viscosity: Angina, dyspnea, claudication, thrombophlebitis
  • Pruritus (itching)
  • Bone pain
  • Fatigue
  • Elevated uric acid levels: waste product
49
Q

Increased Uric Acid causes

A

gout, kidney stones, kidney damage

50
Q

4 Diagnostic Findings for Polycethemia Vera

A
  • Increased HGB & HCT
  • Increased WBC & Platelets
  • Genetic testing– mutation in JAK2 gene **
  • Bone marrow biopsy

Memory: Vera & Jack

51
Q

List 3 Complications for Polycythemia Vera

A
  • blood thickens
  • Increased platelets- functionality of platelets can be impaired leading to increased risk of bleeding
  • Increased risk for venous or arterial thromboses - heart attack, stroke **
52
Q

List 3 Medical Managements for Polycythemia Vera

A
  • Low-dose aspirin
  • Phlebotomy: remove 500 mL blood once or twice weekly - Goal maintain HCT < 45%
  • Meds
53
Q

Important Patient teaching for Polycythemia Vera

A

Avoid Iron supplements and multivitamins

54
Q
  • Type of cancer that originates in the lymphatic system, which is a crucial part of the immune system.
  • Tumors start in the lymph nodes
55
Q

2 types of Lymphoma

A
  1. Hodgkin Lymphoma
  2. Non-Hodgkin Lymphoma
56
Q

Which Lymphoma am I?
* Characterized by the presence of Reed-Sternberg cells **
* Associated with Epstein-Barr Virus
* starts in single lymph nodes and spreads in an orderly fashion

A

Hodgkin’s Lymphoma

57
Q

Hallmark of Hodgkins Lymphoma

A

Reed-Sternberg cells

58
Q

List 2 Clinical Manifestations of Hodgkin Lymphoma

A
  1. First: painless, enlarged lymph nodes
  2. Cluster of symptoms known as “B symptoms”
59
Q

What are the B symptoms

A

Systemic symptoms that include:
* Fever without chills
* Drenching sweats, especially at night
* Unintentional weight loss

60
Q

4 Most important Diagnostics For Hodgkins Lymphoma

A
  • Lymph node biopsy
  • Chest XRAY
  • CT Scan: Identify extent of lymphadenopathy
  • Positron emission tomography (PET) scan: after therapy to determine effectiveness
61
Q

List 2 Main Medical Managements for Hodgkin Lymphoma

A
  • Limited stage - Short course of chemotherapy (2 to 4 months)
  • Radiation- first cancer can do this bc its solid tumor.
62
Q

Nursing Management for Hodgkin Lymphoma

A
  • Monitor for systemic side effects of chemotherapy and radiation
  • High risk of infection
  • complications based on location of radiation
63
Q

2nd type of Lymphoma
* Can originate outside of the lymph nodes (e.g. spleen, thymus)
* Spread can be unpredictable
* Most patient have wide spread disease at time of diagnosis

A

Non-Hodgkin Lymphoma

64
Q

Medical Management Non-Hodgkin Lymphoma

A
  1. Similar to Hodgkin Lymphoma **
  2. Radiation- if not aggressive
  3. Combination chemo/monoclonal antbx (MoAb)
  4. HSCT may be considered for patients younger than 60
  5. Treatment for low WBC
65
Q

Non-Hodgkin Lymphoma:

What 2 meds are used for Treatment of low WBC?

A
  • Filgrastim (Neupogen)
  • Pegfilgrastim (Neulasta)

WBC growth factor

know

66
Q
  • Type of blood cancer that originates in the PLASMA cells
A

Multiple Myeloma

67
Q
  • Where do Plasma cells originate
A

Bone Marrow

68
Q

Multiple Myeloma:

What do these abnormal plasma cells do to the bone?

A

infiltrate the bone marrow and crowd out the healthy blood cells and cause bone destruction

69
Q

Multiple Myeloma:

What do the abnormal plasma cells do to organs?

A

Rather than produce helpful antibodies, the cancer cells produce abnormal proteins (M-proteins) that cause organ damage

70
Q

5 S/S of Multiple Myeloma

A
  1. Bone pain: pelvis, spine & ribs
  2. Bone degeneration
  3. Diffuse (allover) osteoporosis: Myeloma protein destroys bone
  4. Vertebral destruction
  5. Bone fractures
71
Q

4 Diagnostic tests for Multiple Myeloma

A
  • Blood tests
  • Urine tests
  • Bone marrow examination
  • Imaging tests – to detect bone problems
72
Q

Multiple Myeloma:

Blood tests and Urine tests are done to find what exactly?

A

M Proteins - produced by myeloma cells

73
Q

Medical Management for Multiple Myeloma

A

No cure – treatment designed to extend remission or relieve symptoms

74
Q

What EARLY treatment options are available for Multiple Myeloma

A
  1. Corticosteroids (Dexamethasone)- often combined with: Immunomodulatory drug & Proteasonme inhibitor
  2. Autologous Stem Cell Transplant (HSCT)- own stem cells
75
Q

Multiple Myeloma Nursing Management

A
  1. Pain management – NSAIDS
  2. Activity restriction – lifting no more than 10 pounds **
  3. Biphosphonate therapy **
    -Improves bone pain
    -Importance of comprehensive oral hygiene to prevent osteonecrosis of the jaw
  4. Renal function: Maintain urine output of 3L/day

Test 3 (7 decks)

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