Week 9 Flashcards
What is most important to include in comprehensive history?
ROS
Physiology of ALL
Immature abnormal cells leave no room for WBC, RBC, and platelets to be made
How might your patient with ALL present?
- Recurrent infection because of this
- Pallor
- Fatigue, not keeping up with academics (may be misinterpreted as behavioral issues or ADD/ADHD)
- Petechiae (does NOT blanch), nose bleeds
How long are patients treated with ALL?
Girls 2 years
Boy 3 years
Physical findings for pt with ALL?
- Anemia (fatigue, pallor)
- Thrombocytopenia (petechiae, bleeding, purpura) (Does not blanch: petechiae and purpura)
- Neutropenia (fever, recurrent infections)
- Bone pain
Why do ALL patients have bone pain?
Infiltration of bone marrow “packed marrow” causes increased pain
Where do cancer cells like to hide?
CNS & testes
Do ALL patients need a fundoscopic exam? Why?
Yes. R/O papilledema
S&S of testicular involement of ALL?
Unilateral painless testicular enlargement (look for other constitutional signs)
What needs to be evaluated in CBC?
Smear to check for lymphoblasts (not normal)
Hem-onc eval (leukocytes > 10 x 10 occurs in ALL pts)
Will WBC be high or low in ALL?
It can be either!
What are pts with higher WBC at risk for?
Thrombosis
What is pancytopenia?
neutropenia, anemia, and thrombocytopenia due to ALL
Should a cancer pt receive live vaccines?
No (MMR, rubella, varicella)
Can family members get MMR vaccine?
Yes, it does not shed.
Can family members get varicella?
Yes, it does shed, but benefits outweigh risks
Pt reports with recurrent ear infections, pallor, and fatigue. What is your next step?
R/O cancer and consider differentials.
How long is maintenance/continuation therapy?
Females – 2.5 years
Males – 3.5 years d/t testiuclar involvement
**Consult with oncology if pt develops AE during this time