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NURS 470 > Stem Cell and Bone Marrow Transplant > Flashcards

Stem Cell and Bone Marrow Transplant Flashcards

1
Q

Where does hematopoiesis occur in adults?

A

bone marrow and lymphatic tissues

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2
Q

What types of blood cells are derived from stem cells?

A

RBCs, WBCs, and platelets

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3
Q

What is leukemia?

A

malignant disorder in leukocytes

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4
Q

What are the 4 types of leukemia?

A

acute myeloid leukemia, chronic myeloid leukemia, acute lymphoid leukemia, and chronic lymphoid leukemia

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5
Q

What types of cells does myeloid leukemia affect? (6)

A

erythrocytes, platelets, basophils, neutrophils, eosinophils, and monocytes

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6
Q

What types of cells does lymphoid leukemia affect?

A

Natural killer cells, T lymphocytes, and B lymphocytes

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7
Q

What is the difference between acute leukemia versus chronic leukemia?

A

In acute leukemia, immature leukemia cells will continue to reproduce and build up and without treatment, patients typically live only a few months
In chronic leukemia, the cells that build up can mature partly. These leukemia cells can build up and outlive normal cells and they will progress over a long period of time, and patients can live for years with this

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8
Q

What is the pathophysiology of leukemia?

A

lack of normal regulatory mechanisms of bone marrow cell proliferation and maturation

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9
Q

What are general symptoms that will be seen in a patient with leukemia?

A

FEVER, fatigue, night sweats, headaches, SOB, bruising, petechiae, and bone/joint pain

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10
Q

What are secondary symptoms that may be experienced by a patient with leukemia?

A

anemia, leukopenia, thrombocytopenia, swollen lymph nodes, and enlarged liver/spleen

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11
Q

How is the type of leukemia diagnosed?

A

WBC count with differential

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12
Q

What will a patient’s MRI/CT show if they have leukemia?

A

infiltrates and sites of infection

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13
Q

How is neutropenia determined?

A

Absolute Neutrophil Count (ANC) =
[(bands+segs) x WBC count] / 100

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14
Q

What is a normal absolute neutrophil count? What would the count be for someone with leukemia?

A

Normal ANC= 2,500-5,000
ANC <500

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15
Q

Why is having a low absolute neutrophil count very detrimental to a patient’s health?

A

it will severely increase the risk for infection

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16
Q

What are the 3 types of bone marrow transplants?

A

autologous, syngeneic, and allogenic

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17
Q

What is a syngeneic bone marrow transplant?

A

patient receive stem cells from their identical twin

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18
Q

What is an allogenic bone marrow transplant?

A

patient receives stem cells from their brother, sister, or parent. An unrelated donor may also be used

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19
Q

What are examples of supportive care for leukemia?

A

anti-infectives, antipyretics, transfusions, fluids and electrolytes, symptom management, psychological, and spiritual support

20
Q

What are the priority diagnoses for patients with leukemia?

A

infection, injury: bleeding, altered thought processes, anemia-related diagnoses (Fatigue), and ineffective individual/family coping

21
Q

What are the 4 types of stem cell transplants?

A

Haploidentical, autologous, syngeneic, and allogenic

22
Q

What is the nursing care management for a patient that is receiving an autologous stem cell transplant?

A

Place the patient on a cardiac monitor as the dimethyl sulfoxide may cause heart block or bradycardia. Additionally, premedicate the patient with steroids and antiemetics

23
Q

How long can autologous stem cells are cord cells be stored?

A

up to several years

24
Q

Can allogenic stem cells be stored/frozen?

A

No. It is administered following processing and is used within 48 hours of collection

25
Q

what is the temperature for a warm bath for thawing frozen stem cells?

A

38-40 degrees celsius

26
Q

What is a systemic side effect that does not occur in autologous infusions that may occur in allogenic stem cell transfusions?

A

hemolytic transfusion reaction

27
Q

Renal side effects of an autologous stem cell transfusion

A

Hemaglobinuria
Hypertension
Fluid overload
Renal failure

28
Q

How often should vital signs be assessed on Day 0 of a stem cell transplant?

A

Q15 min for 1 hour, Q30 min for 2 hours, and then Q1H for 4 hours

29
Q

How long should a patient be wearing a cardiac monitor when getting a stem cell transfusion?

A

during the transfusion and for 4 hours after completion of infusion

30
Q

What should urine be assessed for during the 4 hours post transplant?

A

heme

31
Q

What can be given to promote engraftment?

A

GCSF/GMCSF (Sargramostin)

32
Q

What lab values are evidence of engraftment?

A

ANC>500 and Platelets greater than or equal to 20,000 without a platelet transfusion

33
Q

When might capillary leak syndrome occur following a transfusion?

A

7-14 days post transfusion is the higher risk period

34
Q

What happens with capillary leak syndrome?

A

increased capillary permeability, which leads to fluid retention/weight gain and can lead to ascites/pulmonary edema

35
Q

How should a nurse assess for capillary leak syndrome?

A

Monitor Is and Os (Q4H), weight, BP, lung sounds

36
Q

What complications of a stem cell infusion may require the need for CRRT?

A

Hemorrhagic cystitis

37
Q

If a patient begins to have hematuria, dysuria, urgency, and bladder spams, what complication of stem cell infusions may this patient be experiencing?

A

hemorrhagic cystitis

38
Q

When might a patient experience veno-occlusive disease?

A

7-12 days after stem cell infusion

39
Q

What happens in veno-occlusive disease?

A

Hepatic obstruction manifested by
Liver enlargement/ascites
↑ bilirubin/LFTs/jaundice
10% weight gain/RUQ pain
Occurs about 7-12 days after transplant

40
Q

What is first line management of veno-occlusive disease?

A

diuretics/fluid restriction

41
Q

When does primary graft failure occur?

A

within 1st 2 months

42
Q

If a patient has a graft failure at 6 months, what kind of failure are they experiencing?

A

secondary graft failure

43
Q

Which 3 organs are damaged with acute graft versus host disease?

A

Skin, GI, and Liver

44
Q

If a patient is 75 days post stem cell transplant reporting green/watery diarrhea, erythema on palms and soles of feet, and RUQ pain, what is suspected to be occurring? What labs would you anticipate to verify this?

A

Acute graft versus host disease.
LFTs should be assessed

45
Q

If a patient is suspected to have chronic GVHD, what labs would you expect to be ordered, why?

A

CBC as this can cause thrombocytopenia
BMP as this can cause malabsorption and dehydration

46
Q

What is the most common cause of death following a stem cell transplant?

A

chronic GVHD

NURS 470 (33 decks)

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