White Blood Cells Disorders

Question 1

Leukemia - Pathophysiology

Answer 1

• Uncontrolled WBC production
  > Cx occurs in stem cells of bone marrow; overcrowded w/ nonfunctional cells
• Overproduction of Blasts cells (immature WBC)
• Exact cause unknown: many genetic & envir’t facotrs involved
  > 50% of pts have abnormal chromosomes
• Normal cell production DCRD
  > Pancytopenia: CMs; neutropenia, anemia, thrombocytopenia infiltration tissue/organ

Question 2

Leukemia - Classifications

Answer 2

• Acute
  > sudden onset abnormal blood cells
• Chronic
  > abnormal cells replicate slowly
• Classified by Cell Type
  > Lymphoid cells: Lymphocytic
  > Myeloid cells: Myelogenous

Question 3

Acute Leukemia Types

ages

Answer 3

• Acute Lymphocytic Leukemia (ALL)
  > most common type in young children
• Acute Myelogenous Leukemia (AML)
  > most common type in all adults

Question 4

Chronic Leukemia Types

ages

Answer 4

• Chronic Lymphocytic Leukemia (CLL)
  > most common chronic adult leukemia
• Chronic Myelogenous Leukemia (CML)
  > asymptomatic for yrs before entering a fast growth phase

Question 5

Leukemia - Risk Factors

Answer 5

• Prior exposure chemotherpay or ionizing radiation
  > prevous cancer
• Bone marrow hypoplasia
• Genetic factors
  > downs
• Immune deficiency
• Virus

Question 6

Leukemia - Diagnosis

Answer 6

• CBC
  > abnormal WBC; high blast cells poorer prognosis
  > low Hgb & Hct and platelets
• Bone Marrow Biopsy
  > definitive test
• Chromosome analysis
• Other X-rays, CAT scans, MRI

Question 7

Leukemia - CMs

psychological
lymph nodes
spleen/liver

Answer 7

• Psychological
  > fatigue
  > loss of appetite
• Lymph Nodes
  > swelling
• Spleen and/or Liver
  > enlargement

Question 8

Leukemia - CMs

skin
systemic

Answer 8

• Skin
  > night sweats
  > easy bruising & bleeding
  > purplish patches or spots
• Systemic
  > weight loss
  > fever
  > frequent infections

Question 9

Leukemia - CMs

lungs
muscular
bones/joints

Answer 9

• Lungs
  > easy SOB
• Muscular
  > weakness
• Bones or Joints
  > pain or tenderness

Question 10

Leukemia - Diagnosis: Bone Marrow Aspiration

Answer 10

• Provides info abt blood cells & production
• Nursing
  > teach pt what to expect
  > position: prone or side-lying
  > sedative provided
  > local anesthetic injected
• Follow-Up Care
  > control bleeding
  > inspect site every 2hrs
  > pain control

Question 11

Leukemia - Medical Treatment

Answer 11

• Induction Therapy
  > intense chemotherpay started as soon as diagnosis confirmed
  > hospitalized 2-3wks in protective isolation
  > Side Effects: severe bone marrow suppression, alopecia, N/V, stomatitis, organ toxicity
• Consolidation Therapy
  > after recovery
  > repeat drugs or bone marrow transplant
• Maintenance Therapy
  > months to yrs to maintain remission

Question 12

Lymphomas

Answer 12

• Cancer of lymphocytes
• 2 main types:
  > Hodgkin’s Lymphoma (HL): “curable”, teens & adults in 50-60s
  > Non-Hodgkin’s Lymphoma (NHL): “non-curable”, all other lymphomas (over 60 types), older adult men
  > many subtypes of both

Question 13

Palpable Nodes

cervical

Answer 13

• Cervical
  > posterior cervical
  > pre-auricular
  > upper cervical
  > median or lower cervical
  > supraclavicular

Question 14

Palpable Nodes

axillary
eiptrochlear
inguinal
popliteal

Answer 14

• Axillary
  > axillary
• Epitrochlear
  > epitrochlear
• Inguinal
  > inguinal
  > femoral
• Popliteal
  > popliteal

Question 15

Non-Palpable Nodes

mediastinal

Answer 15

• Paratracheal
• Mediastinal
• Hilar
• Retrocrural

Question 16

Non-Palpable Nodes

para-aortic

Answer 16

• Para-aortic
• Common iliac
• External iliac

Question 17

Non-Palpable Nodes

mesenteric

Answer 17

• Celiac
• Splenic hilar
• Portal
• Mesenteric

Question 18

Hodgkin’s Lymphoma - Signs/Symptoms

Answer 18

• Starts in a single lymph node in neck, underarm, or chest
  > proceeds in orderly fashion; connect the dots
• Fatigue, anorexia, SOB
• “B” symptoms: sweats, fever, itching, weight loss
• Pain in node areas after alcohol intake

Question 19

Hodgkin’s Lymphoma - Risk Factors

Answer 19

• Viral infections
• Chemical exposure

Question 20

Hodgkin’s Lymphoma - Treatment

Answer 20

• External radiation & chemo
• Curable

Question 21

Non-Hodgkin’s Lymphoma - Symptoms

Answer 21

• Lymphadenopathy in multiple sites
• Already spread to other organs at diagnosis

Question 22

Non-Hodgkin’s Lymphoma - Risk Factors

Answer 22

• Autoimmune disease
• Immunosuppressive disorders
• Viruses
  > HIV, Epstein-Barr
• Chemicals

Question 23

Non-Hodgkin’s Lymphoma - Treatment

Answer 23

• Chemotherapy/monoclonal antibodies
• Radiation
• Chronic disease
  > not curable

Question 24

Multiple Myeloma - Pathophysiology

Answer 24

• Overgrowth of plasma cells (PC)
  > due to overproduction of gamma globulin (gammopathy)
  > excess antibodies in blood clog blood vessels of kidney and other organs then cause infection
• Produce excess cytokines
  > incr cancer growth rate & destroy bone

Question 25

Multiple Myeloma - Diagnostic Tests

Answer 25

- **Serum Electrophoresis Test** > detects monoclonal immunoglobulin - **Bone Marrow** > greater than 10% infiltrated plasma cells - **X-ray** > osteolytic bone lesions

Question 26

Multiple Myeloma - Early CMs

Answer 26

- **Fatigue** - **Anemia** - **Easy bruising** - **Bone pain** - **Infections**

Question 27

Multiple Myeloma - Late CMs

Answer 27

- **Bone factures** > due to infection - **Kidney dysfunction** - **HTN** - **Rare**: > hypercalcemia, hyper viscosity syndrome - **Leads to progressive bome destruction, bleeding, kidney failure, immunosuppression, and death**

Question 28

Multiple Myeloma - Treatment

Answer 28

- **Chemotherapy agents** - **Bone marrow transplant** - **INCURABLE**

Question 29

Multiple Myeloma - Nursing Care

Answer 29

- **Care of immunocompromised pt** - **Pain control**

Question 30

Nursing Care for Leukemia, Lymphoma, & Multiple Myeloma

Answer 30

- **Infection Protection** > prophylactic drugs: antiviral, antibiotic, antifungals > neutropenic precautions > monitor labs daily > monitor for early manis of infection > hygiene/skin care - **Thrombocytopenia precautions** - **Energy conservation** - **Teach self care** > no crowds, identify infection - **Psychosocial support**

Question 31

Neutropenic Precautions

Answer 31

- **Avoid crowds, children/ill ppl/wear mask** - **Hand hygiene/good personal hygiene/mouth care** - **Avoid constipation** - **Shave w/ electric shaver** - **Do not handle feces** - **No fresh flowers/plants/no gardening** - **No invasive procedures** - **No sexual relations** - **Discuss food safety** > no fresh fruits, veggies, raw meat, eggs, some cheeses - **Pt should have thermometer & know how to use it** - **Who to notify & when** > temp greater than 100.5, chills, signs of illness or infection - **Wkly lab** - **Admin growth factor as directed**

Question 32

Thrombocytopenic Precautions

Answer 32

- **Risk for injury: Risk factors: abnormal clotting** - **Assess for S/S of bleeding** > bruises, nose, gums, urine, stool, severe headaches - **Avoid IM/SQ/IV or invasive procedures** - **No Aspirin/NSAID** - **Soft toothbrush: no flossing or dental procedures** - **No razor blades** - **Stool softeners & laxatives to prevent straining** - **Hold pressure for 5 min on venipuncture sites** - **Teach signs of bleeding** > when to notify doc - **Safe envir't** > avoid situations where falls may occue