[Exam 1] Chapter 34 - Management of Patients with Hematologic Neoplasms Flashcards
(211 cards)
1
Q
What are indolent neoplasms?
A
Where the increased number of cells produced from a culprit clone all have the same genotype
2
Q
Leukemia: What is Leukocytosis?
A
Refers to an increased level of leukocytes (WBCs) in circulation. Normaly is only one specific typ eof leukocyte.
3
Q
Leukemia: What is a significant cause of persistent leukocytosis?
A
Hematologic malignancy (leukemia)
4
Q
Leukemia: Common feature of leukemias?
A
Unregulated proliferation of leukocytes in the bone marrow. Leaves little room for normal cell production.
5
Q
Leukemia: What is extramedullary hematopoiesis?
A
Proliferation of cells in liver or spleen, can be caused by leukemia
6
Q
Leukemia: With acute forms, there can be infiltration of leukemic cells in other organs such as
A
meninges, lymph nodes, gums and skin.
7
Q
Leukemia: Leukemias can be classified how?
A
Either lymphoid (referring to stem cells that produce lymphocytes)
Or myeloid (stem cells that produce nonlymphoid blood cells)
8
Q
Leukemia: How quickly do symptoms appear in acute leukemia?
A
Onset abrupt, within weeks.
9
Q
Leukemia: Leukocyte development in acute leukemia?
A
halted at the blast phase, and thus most luekocytes are undifferentiated cells. Can progress rapidly
10
Q
Leukemia: What happens in chronic leukemia?
A
Symptoms evolve over a period of months to years. Majority of leukocytes produced mature.
11
Q
Acute Myeloid Leukemia: What does this result from?
A
Defect in the hematopoietic stem cell that differentiates into all myeloid cells (monocytes, granulocytes (neutrophils, basophils, eosinophils) erythrocytes and platelets.
12
Q
Acute Myeloid Leukemia: Occurs most often with what age group?
A
Rises with age, with peak incidence at age 67
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Q
Acute Myeloid Leukemia, Clinical Manifestation: Signs and symptoms typically result from what
A
insufficient production of normal blood cells
14
Q
Acute Myeloid Leukemia, Clinical Manifestation: What results from neutropenia, anemia, and thrombocytopenia
A
Neutropenia: Fever/Infection
Anemia: Weakness/Fatigue, Dyspnea, Pallor
Thrombocyto: Petechiae, Ecchymoses, and Bleeding Tendencies
15
Q
Acute Myeloid Leukemia, Clinical Manifestation: What are the three main signs of this?
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Neutropenia, Anemia, and Thrombocytopenia
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Acute Myeloid Leukemia, Clinical Manifestation: Proliferation of leukemic cells within organs leads to what signs?
A
Pain from an enlarged liver or spleen, hyperplasia of gums, and bone pain from expansion of marrow.
17
Q
Acute Myeloid Leukemia, Clinical Manifestation: Common sign of this on skin?
A
Petechiae or ecchymoses.
18
Q
Acute Myeloid Leukemia, Assessment: What does a CBC show?
A
A decrease in both erythrocytes and platelets
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Q
Acute Myeloid Leukemia, Assessment: What does a bone marrow analysis show
A
Excess , > 20% , of immature leukocytes, called blast cells. Hallmark diagnossi
20
Q
Acute Myeloid Leukemia, Assessment: Those with acute promyelocytic leukemia have what kind of symptoms
A
potentially fatal bleeding episodes, because they have underlying coagulopathy.
21
Q
Acute Myeloid Leukemia, Medical Mx: Overall objective of treatment?
A
To achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow.
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Q
Acute Myeloid Leukemia, Medical Mx: Remission is achieved by chemotherapy, called induction therapy which involves what
A
high doses of cytarabine or other medications.
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Q
Acute Myeloid Leukemia, Medical Mx: Treatment of APL revolves around what
A
induction therapy using the differentiating agents all-trans retinoic acid, which induces promyelocytic blast cells to differentiate, deterring the blasts from proliferating at an immatuer stage.
24
Q
Acute Myeloid Leukemia, Medical Mx: In AML, induction therapy has a goal of what?
A
Eradicate the leukemic cells. But normal types of myeloid cells erradicated too causing severe neutropenia, leading to anemia and thrombocytopenia
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Acute Myeloid Leukemia, Medical Mx: When the ANC is 0, what signs can the patient be experiencing?
Will have infections, bleeding, and severe mucositis that causes pain, diarrhea, and inability to maintain adequate nutrition.
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Acute Myeloid Leukemia, Medical Mx: Management of this includes what?
Adminisering blood products (packed rbcs) and promptly treating infection. Use granulocytic growth factors to shorten period of significant neutropenia by stimulating the bone marrow to produce l eukocytes more quickly
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Acute Myeloid Leukemia, Medical Mx: What is done when patient has recovered from induction therapy?
Consolidation therapy is given to eliminate any resiudal leukemia cells that are not clinically detectable adn reduce chance for recurrence.
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Acute Myeloid Leukemia, Medical Mx: What is another way to treat this patient?
HSCT. Use aggressive chemotherapy with goal of destroying hematopoietic function of the patients bone marrow, then being "rescued" with infusion of the donor stem cells to reinitiate blood cell production
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Acute Myeloid Leukemia, Medical Mx: Those who under HSCT have a significant risk for what
infection and graft-versus-host disease(where the donors lymphocytes (graft) recognize the patient's body as forieng and set up reactions ot attack the "foreign" host.)
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Acute Myeloid Leukemia, Medical Mx: When would supportive care be recommended?
When they have significant comorbidity like poor cardiac , pulmonary, renal, or hepatic function.
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Acute Myeloid Leukemia, Complications: Complications of this include ?
Bleeding and infection, whcihc an cause death. Bleeding correlates with level and duration of platelet deficiency
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Acute Myeloid Leukemia, Complications: What can a low platelet count cause?
ecchymoses and petechiae.
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Acute Myeloid Leukemia, Complications: Most common bleeding sources include?
GI, pulmonary, vaginal, and intracranial.
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Acute Myeloid Leukemia, Complications: What level of neutrophils increase the risk of infection?
Those < 100 . The longer this goes, the risk of developing fungfal infection increases.
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Acute Myeloid Leukemia, Complications: What happens as massive leukemic cell destruction from chemotherapy occurs?
Release of intracellular electrolytes and fluids into systemic circulation. We see increase in uric acid, potassium, and phosphate and is known as tumor lysis (cell destruction) syndrome
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Acute Myeloid Leukemia, Complications: Increased uric acid and phosphorus levels cause what?
Make the patient vulnerable to renal stone formation and renal colic, which can progress to AKI
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Acute Myeloid Leukemia, Complications: Hyperkalemia and hypocalcemia lead to what
cardiac dysrhythmias, hypotension, neuromuscular effects sucha s muscle cramps, weakness, and spasms
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Acute Myeloid Leukemia, Complications: GI problems may result from what
infiltration of abnormal leukocytes into the abdominal organs and from the toxicity of chemotherapeutic agents. Anorexia, N/V, Diarrhea common.
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Chronic Myeloid Leukemia: This arises from what
mutation in the myeloid stem cell. Normal myeloid cells production, but increase in production of forms of blast cells.
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Chronic Myeloid Leukemia: What happens because of uncontrolled proliferation of cells?
Marrow expands into the cavities of long bones, like femur, and cells are also formed in the liver and spleen., resulting in enlargement of these organs
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Chronic Myeloid Leukemia: How does this happen on chemisry level?
Chromosomal translocation, where section of DNA is shifted from chromosome 22 to chromosome 9. When fusing, they produce an abnormal protein that causes leukocytes to divide rapidly.
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Chronic Myeloid Leukemia: What gene is virutally present witha ll patients wiwth this disease
BCR-ABL gene
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Chronic Myeloid Leukemia - Clinical Manifestations: If asymptomatic, how can leukocytosis be detected?
By a CBC
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Chronic Myeloid Leukemia - Clinical Manifestations: Leukocyte count may get how high
May exceed 100,000
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Chronic Myeloid Leukemia - Clinical Manifestations: PAtients with high leukocyte counts may show what signs
SOB or slightly confused because of decreased perfusion to lungs and brain from leukostrasis (excessive volume of leukocytes inhibit blood flow through capillaries)
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Chronic Myeloid Leukemia - Clinical Manifestations: With there being excess amounts of leukocytes, what organs may be affeceted
there may be an enlarged/tender spleen and liver.
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Chronic Myeloid Leukemia - Clinical Manifestations: What insidious symptoms will they have?
Malaise, anorexia, and weight loss.
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Chronic Myeloid Leukemia - Clinical Manifestations: What are the three stages of this?
Chronic, transofmration and accelerated or blast crisis.
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Chronic Myeloid Leukemia - Clinical Manifestations: What happens during the chronic phase?
Have few symptoms and complications from disease, and infections/bleeding is rare.
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Chronic Myeloid Leukemia - Medical Mx: How does the oral formula of tyrosine kinase inhibitor work?
Works by blocking signals within the leukemia cells taht express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide
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Chronic Myeloid Leukemia - Medical Mx: What kind tyrosine kinase inhibitor therapy do?
Induce complete remission at the cellular, and even molecular level.
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Chronic Myeloid Leukemia - Medical Mx: What may limit absorption and also cause toxicity?
Antacids and grapefruit may limit drug absorption, and large doses of acetaminophen may cause hepatotoxicity.
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Chronic Myeloid Leukemia - Medical Mx: This is a disease that can be potentially cured with what
HSCT in those healthy patients younger than 65.
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Chronic Myeloid Leukemia - Medical Mx: The use of tyrosine kinase therapy has decreased what
the need for transplantation in cML
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Chronic Myeloid Leukemia - Medical Mx: What can occur during the transofmration phase?
Marks process of evolution to the acute form of leukemia. Patient may complain of bone pain and may report fevers.
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Chronic Myeloid Leukemia - Medical Mx: What may happen if the spleen enlarges?/
Patient may become more anemic and thromocytopenic, and an increased basophil level is detected
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Chronic Myeloid Leukemia - Medical Mx: What may ocur in the acute form of CML (blast crisis) treatment may resemble what
induction therapy for acute leukemia, using the same meds as for AML or ALL.
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Chronic Myeloid Leukemia - Nursing Mx: Advances in treatment have changes the course of this disease to what?
From life-threatening and likely fatal to being a chronic disease.
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Chronic Myeloid Leukemia - Nursing Mx: Drugs used to treat CML may cause what side effects?
Fatigue, asthenia, pruritus, headache, skin rash, and oropharyngeal pain are common side effects.
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Chronic Myeloid Leukemia - Nursing Mx: What is used to assess for a major molecular response?
Blood testing using specific polymerase chain reaction (PCR) to detect level of BCR-ABL
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Chronic Myeloid Leukemia - Nursing Mx: What is the most important way to make sure they are treated?
Adherence to therapy is critical for optimal outcomes to be achieved.
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Acute Lymphocytic Leukemia: What is this?
Results from uncontrolled proliferation of immature cells (lymphoblasts) derived form the lymphoid stem cell. The cell of origin is the precursor to B Lymphocytes in 75% of all cases..
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Acute Lymphocytic Leukemia: Most common in which population
young children , with boys affected more often than girls, and the peak incidence is 4 years of age. After 15, uncommon until age 50.
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Acute Lymphocytic Leukemia: How does this respond to treatment?
Is very responsive to treatment, and complete remission are at 85%.
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Acute Lymphocytic Leukemia: What causes there to be a diminished survival?
Increasing age.
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Acute Lymphocytic Leukemia: What cna be done if relapse occurs?
Resumption of induction therapy can be achieved for a second remission. HSCT can also be useful
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Acute Lymphocytic Leukemia, Clinical Manifestations: What do immature lymphocytes do?
Proliferate in the marrow and impede the development of normal myeloid cells. Normal hematopoiesis inhibited, resulting in reduced number of granulocytes, erythrocyes and platelets
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Acute Lymphocytic Leukemia, Clinical Manifestations: Leukocyte counts may be low or high, but there is always what proportion
high proportion of immature cells.
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Acute Lymphocytic Leukemia, Clinical Manifestations: What is most common with this type of leukemia?
leukemic cell infiltration into other organs and include pain from an enlarged liver or spleen and bone pain
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Acute Lymphocytic Leukemia, Clinical Manifestations: What is frequently a sie for leukemic cells?
/CNS, so patients may exhibit cranial nerve palsies or headache and vomiing .
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Acute Lymphocytic Leukemia, Medical Mx: Goal of treatment?
To obtain remission without excess toxicity and with a rapid hematologic recovery so tha additional therapy can be given if needed.
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Acute Lymphocytic Leukemia, Medical Mx: Treamtnet plans are based on what?
genetic markers of the disease as well as risk factors of the patient, primarily age.
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Acute Lymphocytic Leukemia, Medical Mx: What medication is a critical part of the initial induction therapy?
Corticosteorids and vinca alkaloids, because lymphoid blast cells are sensitive to this
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Acute Lymphocytic Leukemia, Medical Mx: Once a patient is in remission, what special testing can be done?
Immunophenotyping, immunoglobulin gene rearrangement, is done to look for residual leukemia cells. Minimum residual testing is a useful prognostic indicator.
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Acute Lymphocytic Leukemia, Medical Mx: Goal of consolidation?
To improve outcomes in those patients at high risk for relapse. HSCT may also be considered.
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Acute Lymphocytic Leukemia, Medical Mx: Therapeutic goal at the time of releapse is what?
Reinitiate treatment to obtain a remission and then move quickly to HSCT. Can improve long-term disease-free survival
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Acute Lymphocytic Leukemia, Medical Mx: The use of corticosteroids to treat ALL increases patients riskf for what
susceptibility to infection, with viral infections being common.
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Acute Lymphocytic Leukemia, Medical Mx: Avascular necrosis can occur with who
patients treated with corticosteroid-based chemotherapy.
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Chronic Lymphocytic Leukemia: Who doese this affect most
Older adults, and most common in western world. Family predisposition exists with this.
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Chronic Lymphocytic Leukemia - Patho: Where does this come from
Malignant clones of B-Lymphocytes. Here, leukemia cells are fully mature. They can escape apoptosis and accumlate in the marrow.
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Chronic Lymphocytic Leukemia - Patho: In early stage, what can lymphocyte count be at?
Can exceed 100,000
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Chronic Lymphocytic Leukemia - Patho: Where do these accumulate?
Within the lymph nodes and spleen. Takes less than 12 months for total number to double.
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Chronic Lymphocytic Leukemia - Patho: What must be done to identify the presence of these maligannt clones?
Imunophenotping the circulating B cells.
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Chronic Lymphocytic Leukemia - Patho: What autoimmune complications can occur?
Autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura.
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Chronic Lymphocytic Leukemia - Patho: What does the reticuloendothelial system do in the autoimmune process?
Destroys the bodys own erythrocytes or platelets.
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Chronic Lymphocytic Leukemia - Patho: Some patients will experience a transofmration into oaggressive lymphoma, known as Richters transofmration. What is this?
REsults in increased lymphadenopathy, splenomegaly, worsening b symtpoms and survival of only a few months
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Chronic Lymphocytic Leukemia - CMs: Many patients show what symptoms?
None, and are diagnosed during regular exam. Increased lymphocyte count always present. Enlarged lymph ndoes common and spleen can also be enlarged.
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Chronic Lymphocytic Leukemia - CMs: Patients can also develop B symtpoms, which is what?
Constellation of symptoms including fevers, drenching sweats, and unintentional weight los. T-Cell function impaired, causing further tumor progression.
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Chronic Lymphocytic Leukemia - CMs: How do these people handle infections later on in advanced disease?
Viral infections can become widely disseminated.
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Chronic Lymphocytic Leukemia - Medical Management: What approach is done for those with no symptoms at time of diagnosis?
Watch and wait aproach used. , but treatment may be initiated sooner in the illness trajectory.
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Chronic Lymphocytic Leukemia - Medical Management: What parameters are considered when treatment is selected?
Clinical stage of disease, disease associated symptoms, and functional status of patients, genetic risk, and extent of prior therapy.
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Chronic Lymphocytic Leukemia - Medical Management: Functional status takes what into consideration?
Incorporates individuals life expenctancy, ability to tolerate agggressive therapy, and ability to perform activites of daily living
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Chronic Lymphocytic Leukemia - Medical Management: What is usually given as initiall therapy?
Immunotherapeutic antibody against CD20, but is ineffective when accompanied by a delevtion of the TP53 gene.
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Chronic Lymphocytic Leukemia - Medical Management: Major side effect of fludarabine
prolonged bone marrow supression, with prolonged periods of neutropenia, ,lymphopenia and thrombocytopenia. which puts them at risk for infections.
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Chronic Lymphocytic Leukemia - Medical Management: Why is MoAb Alemtuzumab (Campath) often used?
USed when patient has poor pronostic markers. Targets the CD52 antigen and effective in clearing the marrow and circulation of these cells without affecting stem cells.
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Chronic Lymphocytic Leukemia - Medical Management: What should be avoided with these patients?
Live vaccines.
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Chronic Lymphocytic Leukemia - Medical Management: Thoughts sabout transplantation like HSCT?
May not be an option due to older age. But can be effective in pateints with P53 deletions.
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Patients with Acute Leukemia: Collaborative problems/potential complications?
Infection
Bleeding / DIC
Renal Dysfunction
Tumor Lysis Syndrome
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Patients with Acute Leukemia - Improving Nutritional Intake: This is often reduced why?
Because of pain and discomfort associated with stomatitis.
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Patients with Acute Leukemia - Improving Nutritional Intake: What can be done before eating to help increase intake?
Encouraging or providing mouth care.
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Patients with Acute Leukemia - Improving Nutritional Intake: Precaution to take if giving oral anesthetic?
Patient must be warned to chew with extreme care.
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Patients with Acute Leukemia - Improving Nutritional Intake: What may be best tolerated by patients?
Small, frequent feedings of food that are soft in texture and moderate in termperature
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Lymphoma: What is this?
Neoplasms of cells of lymphoid origin. Start in lymoh nodes and can involve lymphoid tissue in spleen, GI tract, liver or bone marrow
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Hodgkin Lymphoma: Cure rate?
Rare, has a high cure rate
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Hodgkin Lymphoma: Common with who?
More common with men than with women, and occurs from 15-34 and >60 years. Has a familial pattern.
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Hodgkin Lymphoma - Patho: Where does this begin in?
As single node, and spreads along lymphatic system
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Hodgkin Lymphoma - Patho: What is the malignant cell that causes this?
Reed-Sternberg cell, a gigantic tumor cell that is of immature lymphoid origin. Hallmark sign.
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Hodgkin Lymphoma - Patho: Remaining tumor Reed-Sternberg cell volume is composed of waht?
Benign, reactive inflammatory cells that support the growth of this cell.
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Hodgkin Lymphoma - Patho: What viruses may be implicated in activating the Reed-Sternberg cell?
Fragments of Epstein-Barr, or HIV and herpesvirus 8.
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Hodgkin Lymphoma - Patho: What type of population is this seen in?
Those receiving chronic immunosuppressive therapy (Renal transplant) and veterans exposed to herbicide agent orange.
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Hodgkin Lymphoma - Patho: What would a favorable prognosis consist of?
When lymphocytes predominate with few Reed-Sternberg cells and minimal involvement of the lymph nodes.
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Hodgkin Lymphoma - CMs: How does this usually first show?
With an enlargement of one or more lymph nodes on one side of the neck. Usually cervical, supraclavicular, and mediastinal nodes.
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Hodgkin Lymphoma - CMs: What is the concern with a mediastinal mass?
Can be seen on X-Ray, but if large, can compress the trachea and cause dyspnea.
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Hodgkin Lymphoma - CMs: What abnormalities may they experience?
Pruritus (severe itching on skin) and pain after drinking alcohol.
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Hodgkin Lymphoma - CMs: What part of the body is vulnerable for invasion from the tumor cells?
All organs
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Hodgkin Lymphoma - CMs: Why do symptoms occur?
Result from compression of organs by the tumor, like cough and pulmonary effusion, jaundice (hepatic involvement or bile duct blockage) and abominal pain/bone pain.
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Hodgkin Lymphoma - CMs: Which type of infecction is common?
Herpes Zoster.
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Hodgkin Lymphoma - CMs: B Symptoms are a prime example of this, what are some of this signs?
Fever (without chills), drenching sweats (at night) and unintentional weight loss > 10%
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Hodgkin Lymphoma - CMs: Most common hematologic finding?
Mild anemia.
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Hodgkin Lymphoma - CMs: Leukocyte count here?
May be decreased or elevated.
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Hodgkin Lymphoma - CMs: Platelet count?
Typically normal, unless tumor has invaded boen marrow, suppressing hematopoiesis.
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Hodgkin Lymphoma - CMs: What can be used to assess disease activity?
Erythrocyte sedimentation rate adn serum copper.
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Hodgkin Lymphoma - Assessment/Diagnostic: Diagnosis is made how?
By means of an excisional lymph node biopsy adn frequently, the finding of Reed-Sternberg cells.
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Hodgkin Lymphoma - Assessment/Diagnostic: Once histologic type established, what is done?
Staging. After, evaluation of all palpable lymph node chains.
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Hodgkin Lymphoma - Assessment/Diagnostic: What diagnostics can be performed?
X-Ray / CT scan of chest, abdomen, and pelis.
PET can identify resiual disease.
Bone marrow biopsy routinely performed.
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Hodgkin Lymphoma - Assessment/Diagnostic: Lab tests for hthis?
CBC, platelet count, ESR, and liver/renal function tests.
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Hodgkin Lymphoma - Medical Management: Cure rates for this with this?
If early: 85-90%
If advanced, 65-85%
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Hodgkin Lymphoma - Medical Management: Treatment determined by what?
Stage of the disease, and considerations must be made of potential long-term complications, particularly cardiac disease.
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Hodgkin Lymphoma - Medical Management: Treatment of limited-stage Hodgkin lymphoma commonly involves what
Short couse (2-4 months) of chemotherapy followed by radiation therapy to the specific involved area. Has decreased radiation dosage, and decrease in long-term effects
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Hodgkin Lymphoma - Medical Management: What is the new standard for more advanced disease?
Combination chemotherapy with doxorubicin, bleomycin, vinblastine
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Hodgkin Lymphoma - Medical Management: How does MoAb brentuximb vedotin work for refractory relapsed Hodgkin lymphoma?
Drug targets receptor that expressed on surfacec of activated T and B lymphocytes and on Reed-Sternberg
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Hodgkin Lymphoma - Medical Management: When is HSCT used?
For advanced or refractory disease.
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Hodgkin Lymphoma - Medical Management: What is the leading cause of death in long-term survivors of Hodgkin lymphoma?
SEcond malignancies. Latency period of 5 years after which time the risk progressively increases. Most comon are breast, lung, GI, and skin cancers.
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Hodgkin Lymphoma - Medical Management: What cardiovascular problems can develop 10 years after diagnosis?
Coronary artery disease, dysrhythmias, valvular disease, and cardiomyopathy. CHF, and decreased systolic function.
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Hodgkin Lymphoma - Medical Management: What endocrine problems may occur?
High incidence of anxiety and depression may be reported. Fatigue as well.
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Hodgkin Lymphoma - Nursing Management: What should the nurses be sure to address with the patients?
The potential of development of second malignancy. And should be informed that this is curable.
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Non-Hodgkin Lymphoma: What are these?
Heterogenous group of cancers that originate from neoplastic growths of lymphoid tisue. Cells vary morphologically. Most cases involve malignant B Lymphocytes.
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Non-Hodgkin Lymphoma: How do the lymphoid tissues vary when compared to Hodgkin lymphoma?
Those involved are large infiltrated with malignant cells. Spread of malignany lymphoid cells occurs unpredictably and localized disease uncommon. Multiple lymph nodes may be infiltrated.
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Non-Hodgkin Lymphoma: Median age for this?
66 years.
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Non-Hodgkin Lymphoma: WHo is getting this?
Starting to increase in those with immunodeficiencies or autoimmune disorders, prior tx for cancer, and prior organ transplant.
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Non-Hodgkin Lymphoma, CMs: Most common signs?
Lymphadenopathy, and this can wax-and-wane. Is usually not diagnosed until it progresses to a later stage when symptomatic.
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Non-Hodgkin Lymphoma, CMs: 1/3 of patients have what signs?
B Symptoms (Fever, Night Sweats, and Unintentional Weight Loss).
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Non-Hodgkin Lymphoma, CMs: What problems do lymphomatous masses cause?
Can compromise organ function.
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Non-Hodgkin Lymphoma, Assessment/Diagnostic: ACtual diagnosis is categorized into what classification system?
BAsed on histopathology, immunophenotyping, and cytogenetic analysis.
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Non-Hodgkin Lymphoma, Assessment/Diagnostic: What characteristics do indolent types tend to have?
Small cells that are distributed in a circular or follicular pattern.
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Non-Hodgkin Lymphoma, Assessment/Diagnostic: Aggressive types have what characteristics?
LArge or immature cells distributed through nodes in diffuse patern.
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Non-Hodgkin Lymphoma, Assessment/Diagnostic: Staging determined how?
BAsed on data obtained from CT and PET scans, bone marrow biopsies, and CSF.
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Non-Hodgkin Lymphoma, Assessment/Diagnostic: What classification systems have been developed for older adult population?
International Prognostic Index (IPI) and Follicular Lymphoma (FLIPI)
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Non-Hodgkin Lymphoma, Medical Mx: Tx based on what
classification of disease, stage of disease, prior treatment, and abillity to tolerate therapy
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Non-Hodgkin Lymphoma, Medical Mx: Tolerance to therapy determined by what
renal, hepatic, and cardiac function.
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Non-Hodgkin Lymphoma, Medical Mx: If non aggressve and localized, what is chosen?
Radiation alone may be the treatment.
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Non-Hodgkin Lymphoma, Medical Mx: What is done for aggressive types?
Aggressive combinations of chemotherapeutic agents.
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Non-Hodgkin Lymphoma, Medical Mx: Which ones are not current curable?
Indolent lymphomas, such as follicular lymphoma.
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Non-Hodgkin Lymphoma, Medical Mx: Watchful waiting is another mx option, which is what
where therapy is delayed until symptoms develop.
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Non-Hodgkin Lymphoma, Medical Mx: Patients with limited stage disease will be treated how?
Radiation therapy to affected area.
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Non-Hodgkin Lymphoma, Medical Mx: HSCT is considered for who
Those younger than 60
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Non-Hodgkin Lymphoma, Nursing Mx: When caring for patients with lymphoma, its important for nurse to know what
specific disease type, stage of disease, treatment history and current treatemnt.
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Non-Hodgkin Lymphoma, Nursing Mx: Most commonly used teatment methods for lymphoma are?
Chemotherapy and radiation.
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Non-Hodgkin Lymphoma, Nursing Mx: Chemothrapy causes what side effects
systemic (myelosuppression, nausea, hair loss, risk of infection
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Non-Hodgkin Lymphoma, Nursing Mx: Radiation cuases what side effects
specific side effects to area that is being treated.
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Non-Hodgkin Lymphoma, Nursing Mx: RIsk of infection high, why?
Myelosuppression but also form defective immune response.
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Non-Hodgkin Lymphoma, Nursing Mx: Second malignancies that these patients may fact include what?
Persistent fatigue, depression, anxiety, and pulmonary toxicity.
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Non-Hodgkin Lymphoma, Nursing Mx: Health behavior reccomendations for cancer survivors includes what?
avoiding smoking, maintianing normal body mass, improving nutrition, and engaging in 150 mins of aerobin activity per week.
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Multiple Myeloma: What is this?
Malignant disease of the most mature form of B Lymphocyte, the plasma cell.
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Multiple Myeloma: Plasma cells important why
secrete immunoglobulins, which are proteins necessary for antibody production to fight infection.
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Multiple Myeloma: Staging based on what four criteria?
Serum albumin
Serum lactate dehydrogenase (when elevated, shows poorer prognosis)
Serum beta-2 microglobulim (indrect measure of tumor burden)
Cytogenetic findings
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Multiple Myeloma - Patho: What do malignant plasma cells do here?
Produce an increased amount of a spsecific immunoglobulin that is nonfunctional. Normal ones produced in lower quantities.
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Multiple Myeloma - Patho: What is the specific immunoglobulin that is secreted known as?
Can be detected in blood, and is known as monoclonal protien, or M protein. Is useful marker to monitor extent of disease.
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Multiple Myeloma - Patho: how is M protein usually monitored?
By the serum or urine protein electrophoresis.
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Multiple Myeloma - Patho: What may be elevated because of M protein?
total protein level
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Multiple Myeloma - Patho: What else do malignant plasma cells secrete?
Certain substances to stimulate angiogensis to enhance growth of clsuters of plasma cells.
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Multiple Myeloma - Patho: Plasmacytomas may occur, which is what?
When plasma cells infiltrate other tissues. Can occur in sinuses, spinal cord and soft tissues.
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Multiple Myeloma - Patho: What is the premalignant stage or myeloma known as
monoclonal gammopathy of undetermine significant or MGUS.
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Multiple Myeloma - Patho: End-organ dysfunction can be seen with this, and uses CRAB. What does this stand for
Elecated calcium
Renal insufficiency
Anemia
And/Or Bone lesions
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Multiple Myeloma - CM: CMs of disease result fro what
from malignant cells and also the abnormal protein they produce.
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Multiple Myeloma - CM: What to know about bones?
Bone disease present in 80% of cases.
Bone pain majorily reported.
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Multiple Myeloma - CM: Classic presenting sign of this?
BOne pain, usuall in the back or ribs. Pain increases with movement. WIll report less pain on awakening. .
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Multiple Myeloma - CM: Why are osteoclasts stimulated?
Due to osteoclast activating factor and Interleukin-6 being secreted by plasma cells. Involved with bone breakdown. .
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Multiple Myeloma - CM: What will be seen on bone imaging due to this disease?
Lytic lesions and osteoporosis.
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Multiple Myeloma - CM: Bone destruction can be severe enough to cause what?
Vertebral collapse and fractures, including spinal fractures. WHen it does, height reduced and kyphosis occurs.
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Multiple Myeloma - CM: What happens to electrolytes if bone destruction extensive?
Calcium enters serum, and hypercalcemia occurs.
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Multiple Myeloma - CM: Signs of hypercalcemia?
Excessive thirst, dehydration , constipation, AMS, confusiona dn perhaps coma. Kidney failure may occur too.
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Multiple Myeloma - CM: An older adult that complains of what should be evaluated for possible myeloma?
WHose chief complaint is back pain and who has an electated total protein level
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Multiple Myeloma - CM: What happens to bone marrow has more and more malignant plasma cells produed
Bone marow has less space for erythrocyte production, and anemia may occur. Also caused by decrease erythropoietin production by kidney.
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Multiple Myeloma - CM: Why is infection a problem here?
Due to lack of adequate levels of nromal immunoglobulin, and other alterations of immune sysem.
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Multiple Myeloma - CM: Therapy predisposes patient for acquiring infection why
due to high levels of corticosteroids used in treaing idisease.
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Multiple Myeloma - CM: What neurologic manifestations can occur?
Spinal cord compression, and peripheral nerve compression can occur.
Peripheral neuropathy can occur as well.
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Multiple Myeloma - CM: PLasma cells can secrete excessive amount of imunoglobulin, and viscosity can increase. Signs of hyperviscosity?
Bleeding from nose or mouth, headache, blurred vision, paraesthesias, or heart failure.
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Multiple Myeloma - CM: Thromboembolic events (blood clots) may occur and risk increased when?
When high doses of corticosteroids and immunomodulatory drugs used.
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Multiple Myeloma - Assessment/Diagnostic: Major criteria for diagnosis here?
Elevated monoclonal protein level in serum, urine, or light chain ratio.
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Multiple Myeloma - Assessment/Diagnostic: What else is used to establish diagnosis?
Evidence of end organ damage, using acronym CRAB.
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Multiple Myeloma - Assessment/Diagnostic: Diagnosis confirmed how
Bone marrow biopsy
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Multiple Myeloma - Medical Management: Cure for this?
There is none. HSCT is considered to extend remission. Possible to control illness however
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Multiple Myeloma - Medical Management: Primary tx for those not using HSCT?
Chemotherapy
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Multiple Myeloma - Medical Mx, Early Tx Option: When do people want to start treatment here?
Initiate therapy prior to development of CRAB features, when myeloma is considered smoldering.
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Multiple Myeloma - Medical Mx, Early Tx Option: What meds form the backbobne of myeloma therapy?
Corticosteoids, particularly dexamethasone
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Multiple Myeloma - Medical Mx, Autologous Stem Cell Transplant: What determines eligibility for this?
Patients age, functional status, and comorbidites.
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Multiple Myeloma - Medical Mx, Autologous Stem Cell Transplant: Initial treatment here focused on hat
reducing the amount of tumor burden (decrease the number of myeloma cells and reducing monoclonal protein) without damaging patients stem cells which are used latere.
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Multiple Myeloma - Medical Mx, Pharm Therapy: What two drugs have been developed to help with this?
Immunomodulatory drugs (IMiDs): have broad anti-myeloma effect by inhibiting angiogenesis.
Proteasome Inhibitors: Needed to process and clear excess proteins produced.
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Multiple Myeloma - Medical Mx, Pharm Therapy: Common side effect for someone using thaliodomide?
Fatigue, dizziness, constipation, rash, and peripheral neuropathy. Myelosuppression is not a problem.
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Multiple Myeloma - Medical Mx, Pharm Therapy: Side effects of Bortezomib (a PRoteasome Inhibitor)
TRansient thrombocytopenia, orthostatic hypotension, N/V, Skin Rash, Neuropathy, and Asthenia
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Multiple Myeloma - Medical Mx, Pharm Therapy: What do corticosteroids do here?
Induce apoptosis in myeloma cells and decrease bone pain
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Multiple Myeloma - Medical Mx, Pharm Therapy: Long term effects of corticosteroids can cause what prolems
Infection, VTE, Proximal Muscle Weakness, Osteoporosis, cataract formation, mood, and behavior changes
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Multiple Myeloma - Mging Complications: What is done when lytic lesions result in compression fractures?
Vertebroplastly may be performed.
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Multiple Myeloma - Mging Complications: What is done when patients have significant signs of hyperviscosity?
Plasmapheresis may be used to lower the immunoglobulin level.
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Multiple Myeloma - Nursing Mx: What may be given for pain?
NSAIDS in combination wiht opioid analgesics.
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Multiple Myeloma - Educate about Self Care: What is the most important thing to educate patient on?
Activity restrictions, lifting no more than 10 lbs. ALso will need a brace.
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Multiple Myeloma - Educate about Self Care: What to know for biphosphonate therapy?
Brush teeth daily, diminishes likelihood of developing osteonecrosis of the jaw.
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Multiple Myeloma - Educate about Self Care: What to know for kidneys?
Monitor renal function. Can become severe and dialysis needed. Maintain high urine output
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Multiple Myeloma - Educate about Self Care: What may be a major side effect seen in 50% of patients?
Peripheral neuropathy. Can be disabling and interfere with patients ability to perform normal activites.
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Multiple Myeloma - Educate about Self Care: What should they do if neuropathy occurs?
Report symptoms because cessation or reducing doses may diminish the worsening nerve damage.
