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Nurs 2500 > Class 19 review > Flashcards

Class 19 review Flashcards

1
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6
Q

Is primary polycythemia preventable?

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No

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7
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How is secondary polycythemia generated?

A

Any source of hypoxia, maintaining adequate oxygenation may prevent problems

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8
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Leukemia definition

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A broad term given to a group of malignant diseases that affect the blood and blood-forming tissues of the bone marrow, lymph system, and spleen

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9
Q

Acute leukemia is characterized by…

A

The development of immature hematopoeitic cells

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10
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Chronic leukemias involve…

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More mature forms of WBCs, and the disease onset is more gradual

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11
Q

The 4 types of leukemia

A

Acute Myelogenous Leukemia (AML)

Acute Lymphocytic Leukemia (ALL)

Chronic Myelogenous Leukemia (CML)

Chronic Lymphocytic Leukemia (CLL)

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12
Q

Acute Myelogenous Leukemia (AML)

A
  • 80% acute leukemias in adults
  • Abrupt and dramatic
  • Serious infections can result and abnormal bleeding
  • Uncontrolled proliferation of myeloblasts
  • Normal hematopoeitic cells are replaced by leukemic myeloblasts - can also infiltrate other organs
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13
Q

Acute Lymphocytic Leukemia (ALL)

A
  • Most common leukemia in children
  • Immature small lymphocytes proliferate in bone marrow
  • Most are B-cell origin
  • Fever, bleeding can start abruptly
  • Progressive weakness, fatigue, and bleeding can also occur over time
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14
Q

Chronic Myelogenous Leukemia (CML)

A
  • Excessive development of mature neoplastic granulocytes
  • Move into the blood and infiltrate liver and spleen
  • These blood cells contain the Philadelphia chromosome
  • Chronic stable phase → acute aggressive phase called blastic phase
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15
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Chronic Lymphocytic Leukemia (CLL)

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  • Most common in adults
  • Production of functionally inactive but long-lived mature lymphocutes
  • Usually B cells
  • Lymphocytes invade liver, spleen, and bone marrow
  • This invasion causes enlarged nodes, increased infection, and pressure on organs due to lymph node enlargement
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16
Q

Laboratory findings of acute myelogenous leukemia (AML)

A
  • Low RBC count, Hb, Hct
  • Low platelet count
  • Low to high WBC count
  • High LDH
  • Hypercellular bone marrow
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17
Q

Laboratory findings of acute lymphocytic leukemia (ALL)

A
  • Low RBC count, Hb, Hct
  • Low platelet count
  • Low, normal, or high WBC
  • High LDH
  • Hypercellular bone marrow
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18
Q

Laboratory findings of chronic myelogenous leukemia (CML)

A
  • Low RBC count, Hb, Hct
  • High platelet count early, lower count later
  • Increased neutrophils
  • Normal lymphocytes
  • Normal or low monocytes
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19
Q

Laboratory findings of chronic lymphocytic leukemia (CLL)

A
  • Mild anemia
  • Thrombocytopenia with disease progression
  • Increase WBC, lymphocytes
20
Q

What is a lymphocyte?

A

A type of white blood cell that is part of the immune system. Two types: B and T cells. The B cells produce antibodies that are used to attack invading bacteria, viruses, and toxins.

21
Q

Laboratory findings of pancytopenia

A

Low RBC, Low Plt, Low WBC

22
Q

Symptoms of leukemia

A

Weight loss, chills, night sweats

Fatigue with progressive weakness

Dyspnea, cough

Nausea, vomiting

Hematuria, decreased UO

Diarrhea, dark or bloody stools

Easy bruising

Headaches, confusion

23
Q

Polycythemia description

A

Hyperviscosity and hypervolemia

24
Q

Polycythemia complications

A

Hypertension

Vessel distension

Impaired blood flow

Circulatory stasis

Thrombosis

Tissue hypoxia

25
Q

Clinical manifestions of polycythemia

A

Headache, vertigo, dizziness

Pruritus exacerbated by a hot bath

Painful burning and redness of the hands and feet

Plethora - ruddy complexion

Angina, HF, intermittent claudication

Thrombo-phlebitis

26
Q

Etiology of leukemia

A

No single causative agent

A combination of factors:

Chromosomal changes

Chemical agents

27
Q

Proto-oncogenes

A

Regulate normal cellular processes such as promoting growth “turn on” replication in the cell

28
Q

Tumour supressor genes

A

Suppress growth

29
Q

Acute Myelogenous Leukemia (AML) Clinical Manifestations

A

Weight loss, malaise

Bone pain

Leukocytosis on bloodwork

Increased uric acid, potassium, LDH on bloodwork

Gout

30
Q

Types of chemotherapy for leukemia

A

Intensification therapy

Consolidation therapy

Maintenance therapy

31
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Why are multiple drugs used to treat leukemia?

A

Decrease drug resistance

Minimize drug toxicity

Interrupt cell growth at multiple points in the cell cycle

32
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Cytotoxic agents (chemotherapy) MOA and types

A

Drugs that kill cells directly by damaging DNA or interrupting mitosis

Cell-cycle non-specific

Cell-cycle specific

33
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Bone marrow suppression

A

Myelosuppression reduces number of neutrophils, platelets, and erythrocytes

34
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Neutropenia definition

A

“weakened immune system” increases incidence and severity of infection. Typically begins a few days after dosing, and the nadir occurs 10-14 days, with neutrophils recovering about a week later

35
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Nadir

A

Lowest neutrophil count (peak of the bone marrow suppression caused by cancer treatment)

36
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Thrombocytopenia

A

Low platelet count increased risk for serious bleeding

37
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Anemia

A

Reduced red blood cells. Less common than neutropenia or thrombocytopenia as RBCs lived for 120 days allowing erythrocytes to recover before they drop too low

38
Q

Collaborative management for bone marrow suppression

A

Monitor lab values like neutrophil count. Must be returned to normal before next dose. Assess the need for platelet or RBC transfusions

Monitor for signs or symptoms of infection: fever is earliest

Educate on infection control

Monitor for signs and symptoms of blood loss

Avoid use of blood thinners

Hematopoietic drugs: promote the function of cells in the bone marrow

39
Q

Digestive tract injury

A

Damages the epithelial lining of the GI tract

40
Q

Stomatitis

A

Inflammation of the oral mucosa, typically develops a few days after chemotherapy has begun and may persist for weeks. Can cause severe pain

41
Q

Diarrhea

A

Inflammation of intestines, rectum, and anus. Impairs absorption of fluid and other nutrients

42
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Collaborative management for digestive tract injury

A

Pain management:

Mild: oral mouthwash with topical anesthetic (lidocaine) mouthwash and antihistamine (diphenhydramine)

Severe: systemic opioid

Bland, calorie dense diet

Good oral hygiene

Monitor for and treat oral yeast infection

Treat (loperamide) and support patients care with diarrhea

Monitor fluid and electrolyte imbalances

43
Q

Collaborative management of nausea and vomiting

A

Treat with antiemetics: Ondansetron (Zofran), dimenhydrinate (Gravol)

Monitor fluid and electrolyte imbalances, treat accordingly

Encourse PO (food and fluid) intake

44
Q

Other toxicities of cancer treatment

A

Alopecia: reversible hair loss resulting from injury to hair follicles

Reproductive toxicity: to a developing fetus, ovaries, testes and cause atrophy of the vaginal epithelium. Fetus is most impacted. Can cause irreversible sterility in males

Carcinogenesis drug induced damage to DNA. May take years for secondary cancer to appear

45
Q

What does petechiae tell us?

A

Something has happened to the clotting of blood

46
Q

LDH

A

Lactate dehydogenase hormone. Represents the increase in the cellular damage

Nurs 2500 (16 decks)

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