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Patient Centered Care 3 > Cellular Regulation: Leukemia Exemplar > Flashcards

Cellular Regulation: Leukemia Exemplar Flashcards

1
Q

What is the basic pathophysiology of Leukemia?

A

Cells in the bone marrow make WBCs that don’t work right and they start to go throughout the whole body. They eventually replace cells that make RBC and other blood products. Due to these factors, this creates anemia and makes the patient vulnerable to infections.

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2
Q

What is acute lymphoblastic leukemia and who does it affect?

A
  1. Abnormal growth of marrow cells that form lymphocytes

2. Primarily affects children and young adults; rapid onset and disease progression

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3
Q

What are the clinical manifestations of Acute Lymphoblastic leukemia?

A
  1. Weakness
  2. Decreased energy
  3. Recurrent infections
  4. Bleeding
  5. Pallor
  6. bone pain
  7. weight loss
  8. sore throat
  9. night sweats
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4
Q

What is Chronic lymphocytic leukemia and who does it primarily affect?

A
  1. Abnormal growth of the marrow cells that form lymphocytes

2. Primarily affects older adults; insidious onset and slow, chronic course

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5
Q

What are the clinical manifestations of chronic lymphocytic leukemia?

A
  1. fatigue
  2. exercise
  3. intolerance
  4. Lymphadenopathy
  5. Splenomegaly (enlargement of the spleen)
  6. recurrent infections
  7. pallor
  8. edema
  9. Thrombophlebitis
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6
Q

What is acute myeloid leukemia and who is primarily affected by it?

A
  1. Abnormal growth of marrow cells that form RBCs, WBCs, and platelets
  2. Common in older adults, rarely seen in children and young adults
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7
Q

What are the clinical manifestations of acute myeloid leukemia?

A
  1. fatigue
  2. weakness
  3. fever
  4. anemia
  5. headache
  6. bone and joint pain
  7. abnormal bleeding and bruising
  8. recurrent infections
  9. Lymphadenopathy, splenomegaly, and hepatomegaly
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8
Q

What is chronic myeloid leukemia and who does it primarily affect?

A
  1. Same as acute myeloid leukemia just more long term

2. Primarily affects adults; usually associated with Philadelphia chromosome

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9
Q

What are the risk factors for leukemia?

A
  1. Men more than women
  2. Children with immunodeficiency states
  3. People who have undergone treatment for cancer
  4. The human T-cell leukemia/lymphoma virus 1
  5. genetic disorders (Down syndrome, Bloom syndrome)
  6. Cigarette smoking, exposure to chemicals such as benzene, and exposure to high-dose ionizing radiation
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10
Q

What are the general manifestations of leukemia (regardless of the type)?

A
  1. anemia (pallor, fatigue, tachycardia, malaise, lethargy, and dyspnea on exertion)
  2. infection
  3. bleeding (Bruising, petechia, bleeding gums, and bleeding within specific organs and tissues)
  4. Infiltration of the liver, spleen, lymph nodes and bone marrow causes pain and tissue swelling
  5. Meningeal infiltration may cause manifestations of increased intracranial pressure, such as headache, altered level of consciousness, cranial nerve impairment, and nausea and vomiting
  6. infiltration of the kidneys
  7. heat intolerances
  8. weight loss
  9. dyspnea on exertion
  10. tachycardia
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11
Q

What is an allogeneic bone marrow transplant?

A

Uses bone marrow cells from a donor that is often from a sibling with closely matched tissue antigens; a closely matched unrelated donor also may be used

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12
Q

What is an autologous bone marrow transplant?

A

the patient’s own bone marrow to restore bone marrow function after chemotherapy or radiation

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13
Q

What medications are usually used for acute myeloid leukemia?

A
  1. Cytarabine with daunorubicin or idarubicin

2. All-trans retinoic acid added for patients with promyelocytic leukemia

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14
Q

What medications are usually used for chronic myeloid leukemia

A
  1. Imatinib mesylate

2. Hydroxyurea or homoharringtonine

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15
Q

What medications are usually used for Acute Lymphocytic leukemia (ALL)

A

Daunorubicin with vincristine with prednisone with asparaginase

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16
Q

What medications are usually used for chronic lymphocytic leukemia (CLL)?

A
  1. Fludarabine or Chlorambucil
  2. Cyclophosphamide, vincristine, and prednisone
  3. Cyclophosphamide, doxorubicin, vincristine, and prednisone
17
Q

What is the purpose of chemotherapy for leukemia?

A

To eradicate leukemic cells from the bone marrow

18
Q

What is tumor lysis syndrome?

A

When a large number of malignant cells are destroyed by treatment with chemotherapy or radiation. Patients who are on chemotherapy for leukemia are at risk for developing it.

19
Q

What kind of cancer is most common in children?

A

Leukemia

20
Q

What type of leukemia is most common in children?

A

ALL (Acute Lymphocytic Leukemia)

21
Q

How could a nurse prevent and manage adverse medication effects for someone with leukemia?

A
  1. Obtain daily weight measurements
  2. Evaluate the infusion site before and frequently during infusion
  3. Monitor intake and output
  4. Look for signs of lysis of the cancer cells
  5. renal function must be carefully monitored in patients receiving cyclophosphamide (Hematuria is a side effect of this drug)
  6. Administer prescribed medications, such as allopurinol and diuretics, as ordered
22
Q

What are the ways to protect a person from injury related to bleeding?

A
  1. Instruct the patient to avoid forceful blowing or picking of the nose, forceful coughing or sneezing, and straining to have a bowel movement
  2. Monitor and promptly report abnormal blood levels of electrolytes, uric acid, urea nitrogen, and creatinine or manifestations of TLS.
  3. Assess vital signs every 4 hours and body systems every shift for bleeding
  4. Avoid invasive procedures, such as taking the temperatures rectally and the use of suppositories, vaginal douches and suppositories, tampons, urinary catheterization, and parenteral injections, if possible.
  5. Apply pressure to injection sites for 3-5 minutes and to arterial punctures for 15-20 minutes.
23
Q

What are the assessments that a nurse should do to look for signs of bleeding?

A
  1. Skin and mucous membranes for petechiae, ecchymoses, and purpura
  2. Gums, nasal membranes, and conjunctiva for bleeding
  3. Vomitus, stool, and urine for visible or occult blood
  4. Vaginal bleeding
  5. Prolonged bleeding from puncture sites
  6. Neurologic changes, such as headache, visual changes, altered mentation, decreased level of consciousness, and seizures
  7. Abdomen for complaints of epigastric pain, diminished bowel sounds, increasing abdominal girth, rigidity, or guarding

Patient Centered Care 3 (19 decks)

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