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Nurs 2500 > Class 19 review > Flashcards

Class 19 review Flashcards

(46 cards)

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1
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6
Q

Is primary polycythemia preventable?

A

No

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7
Q

How is secondary polycythemia generated?

A

Any source of hypoxia, maintaining adequate oxygenation may prevent problems

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8
Q

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
Q

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
Q

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)

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

What is a lymphocyte?

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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

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A

Low RBC, Low Plt, Low WBC

22
Q

Symptoms of leukemia

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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

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A

Hyperviscosity and hypervolemia

24
Q

Polycythemia complications

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A

Hypertension

Vessel distension

Impaired blood flow

Circulatory stasis

Thrombosis

Tissue hypoxia

25
Clinical manifestions of polycythemia
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
Etiology of leukemia
No single causative agent A combination of factors: Chromosomal changes Chemical agents
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Proto-oncogenes
Regulate normal cellular processes such as promoting growth "turn on" replication in the cell
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Tumour supressor genes
Suppress growth
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Acute Myelogenous Leukemia (AML) Clinical Manifestations
Weight loss, malaise Bone pain Leukocytosis on bloodwork Increased uric acid, potassium, LDH on bloodwork Gout
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Types of chemotherapy for leukemia
Intensification therapy Consolidation therapy Maintenance therapy
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Why are multiple drugs used to treat leukemia?
Decrease drug resistance Minimize drug toxicity Interrupt cell growth at multiple points in the cell cycle
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Cytotoxic agents (chemotherapy) MOA and types
Drugs that kill cells directly by damaging DNA or interrupting mitosis Cell-cycle non-specific Cell-cycle specific
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Bone marrow suppression
Myelosuppression reduces number of neutrophils, platelets, and erythrocytes
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Neutropenia definition
"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
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Nadir
Lowest neutrophil count (peak of the bone marrow suppression caused by cancer treatment)
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Thrombocytopenia
Low platelet count increased risk for serious bleeding
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Anemia
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
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Collaborative management for bone marrow suppression
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
Digestive tract injury
Damages the epithelial lining of the GI tract
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Stomatitis
Inflammation of the oral mucosa, typically develops a few days after chemotherapy has begun and may persist for weeks. Can cause severe pain
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Diarrhea
Inflammation of intestines, rectum, and anus. Impairs absorption of fluid and other nutrients
42
Collaborative management for digestive tract injury
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
Collaborative management of nausea and vomiting
Treat with antiemetics: Ondansetron (Zofran), dimenhydrinate (Gravol) Monitor fluid and electrolyte imbalances, treat accordingly Encourse PO (food and fluid) intake
44
Other toxicities of cancer treatment
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
What does petechiae tell us?
Something has happened to the clotting of blood
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LDH
Lactate dehydogenase hormone. Represents the increase in the cellular damage

Nurs 2500 (16 decks)

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