NURS 444 week 7

Question 1

Leukemia patients

Answer 1

are vulnerable to anemias and infections

Question 2

Goal for leukemia

Answer 2

eliminate all leukemia cells

Question 3

Lymphomas

Answer 3

cancer of WBC in bone marrow or lymph nodes

Question 4

ALL: acute lymphocytic leukemia

Answer 4

most common in childhood

most are B cell origin

Question 5

AML: acute myelogenous leukemia

Answer 5

most common adult type with a poor prognosis

25% of all leukemias
80% of these are in adults

uncontrolled proliferation of myeloblasts.
Bone marrow hypertrophy

Question 6

CLL: chronic lymphocytic leukemia

Answer 6

found more in adults >60

most common in adults

affects mainly B cells

Question 7

CML: chronic myeloblastic leukemia

Answer 7

mostly adults, rare in children

Philadelphia chromosone present in 90%

Question 8

Leukostasis

Answer 8

life-threatening complication

high leukemic WBC count in the peripheral blood: > 100,000

Blood thickens and blocks circulatory pathways

Question 9

Leukemia Diagnosis

Answer 9

• WBC count: 20,000- 100,000 prior to tx
• H&H, platelets decreased
• bleeding time increased
• bone marrow biopsy
• lymph node biopsy for lymphoma
• Lumbar puncture, PET/CT scan for leukemic cells outside blood or bone marrow

Question 10

Leukemia Treatment Goal

Answer 10

attain remission

Question 11

Stem cells

Answer 11

autologous- clients own cells

syngeneic- from identical twin

allogenic- HLA matched donor or from umbilical cord transpalnt

Question 12

Complications of Leukemia

Answer 12

!! Neutropenia: report ANC <2000 and report temp > 37.8 (100 F) NOTIFY IF TEMP IS 99.5

!! Thrombocytopenia: greatest risk < 50,000

!! Anemia

!! bone marrow transplant complications: failure to engraft, rejection, phlebitis

Question 13

Diverticulitis

Answer 13

multiple pouches in the colon that get infected

common in older adults

can cause perforation, fistula, abcess, bleeding

common if left descending colon

Question 14

Common causes of diverticulitis

Answer 14

• genetic and environmental factors
• obesity
• low fiber intake
• inactivity
• smoking
• excess alcohol and NSAID use

Question 15

Diverticulosis: manifestations and complications

Answer 15

• bloating, abd. pain, flatulence, changes in bowel habits

Serious: bleeding, diverticulitis

Question 16

Symptoms of diverticulitis and complications

Answer 16

• acute pain in LLQ, distention, decreased or absent BS, nausea, vomiting, systemic symptoms of infection

older adults: afebrile, normal WBC, possible abd. tenderness

COMPLICATIONS
-erosion of bowel wall/ perforation
-abscess
-peritonitis
-bleeding

Question 17

Diverticulitis Diagnostic studies

Answer 17

usual: sigmoidoscopy/ colonoscopy

Preferred: CT w/ oral contrast
- occult blood
- CBC, UA
- barium enema
- blood cultures
- abd. x-ray or chest x-ray: rule out other causes

Question 18

Goal of acute diverticulitis

Answer 18

bowel rest to reduce inflammation

• clear liquids, bed rest, analgesia
• if severe; hospitalization; NPO, NGT, bed rest, IV fluids w/ antibiotics.

surgical resection w/ anastamosis, or temporary colostomy if recurring

Question 19

Inflammatory Bowel Disease

Answer 19

chronic recurrent inflammation of GI tract.Common in teens and early adulthood. Peak in 60s

Ulcerative colitis
Chron’s disease

Question 20

IBD: etiology and pathophysi.

Answer 20

actual cause is unknown
Autoimmune disease: environmental or bacterial trigger causes an overactive, inappropriate, sustained immune response in a genetically susceptible person

200 genes associated

Question 21

IBD: environmental factors

Answer 21

• diet, smoking, stress after microbial flora
• high intake of refined sugar, fat, polyunsaturated fatty acid, omega-6 fatty acid
• low intake of raw fruit, veggies, omega- 3 foods, dietary fibers

Drug associations: NSAIDs, antibiotics, oral contraceptives