Exam 2 Review Flashcards
1
Q
infection
A
the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response1
2
Q
acute infection
A
infection resolving in a few days or weeks
3
Q
chronic infection
A
infection lasting longer than 12 weeks and in some cases is incurable
4
Q
localized infection
A
infection limited to a specific body area
5
Q
disseminated infection
A
a spread of infection from an initial site to other areas of the body
6
Q
systemic infection
A
an infection that affects the body as a whole or has spread throughout the body
7
Q
epidemic
A
situation in which there are more cases of an infectious disease than is normal for the population or geographic areas
8
Q
pandemic
A
worldwide epidemic of a disease
9
Q
how do bacteria cause cellular injury
A
- by releasing toxins (either endotoxins or exotoxins)
- diseases caused by bacterial invasion depend on the type of bacterial pathogen and the area of the body primarily invaded
10
Q
how do viruses cause injury
A
- may immediately cause injury disease or remain relatively dormant for years
- cause cellular injury by blocking its genetically prescribed protein synthesis process
- diseases develop as a result of interference of normal cellular functioning of the host, with destruction of the virus by the immune system also requiring death of the host cell
11
Q
how do fungal infections cause injury
A
- in a healthy individual, fungi do not cause disease and are contained in the body’s natural flora
- athlete’s foot and ringworm may develop in the individual with a competent immune system
- in the immunocompromised individual, fungi can result in infections that result in death
12
Q
how do protozoa/parasites cause injury
A
- generally infect people with compromised immune responses
- typically found in dead material in water and soil
- spread by the fecal-oral route by ingesting contaminated food or water
- disease may develop in a healthy individual when spores invade organs and stimulate an immune response
13
Q
secondary infection
A
an infection that develops that begins as one type and after an additional pathogen is introduced, a secondary infection occurs
14
Q
example of secondary infection
A
- fungal infections may develop when treatment for a bacterial infection decimates the body’s natural flora
- bacterial infections may arise while a debilitated body is treated for viral infection
15
Q
healthcare acquired infection example
A
- MRSA
- C. diff
- VRE
16
Q
healthcare acquired infection
A
- infection acquired during a hospital stay
17
Q
community acquired infection
A
infections acquired in the community
ex.
- sporting areas
- areas where children gather for sporting and other events
- restaurants
- food stores and other shopping facilities
- movie theaters
- other group activity locales
18
Q
multidrug resistant organisms (MDROs)
A
19
Q
Chain of Infection
A
- 6 components:
- pathogen
- susceptible host
- reservoir
- portal of exit (from the reservoir)
- mode of transmission
- portal of entry (to the susceptible host)
20
Q
reservoir
A
- anywhere the pathogen may live and multiply, either in the body or on objects within the environment contaminated with the organism
- ex:
- door handles
- stagnant water
- healthcare equipment
21
Q
portal of exit
A
- way out
- the germ that needs to find a way out of the infected person so it can spread
- urine
- feces
- saliva
- blood
- skin
- GI tract
22
Q
portal of entry
A
- the germ needs to find a way into another person
- this can be through the eyes and mouth, hands, open wounds, and any tubes put into the body such as a catheter or feeding tube
- broken skin
- intimate sexual contact
- mouth
- respiratory tract
- gastrointestinal tract
- contaminated food or water
23
Q
means of transmission
A
- once the germ is out it can spread from one person to another by hands or an equipment such as a commode, in the air by coughing or contact with body fluids and blood
- direct contact
- ingestion
- airborne
24
Q
susceptible host
A
- a person who is at risk of infection because they are unable to fight the infection
- could be residents, staff or visitors
- elderly people can have decreased immune systems and catch infections easier
- infections also spread quickly in care homes due to many residents living closely together
- immunosuppression
- diabetes
- surgery
- burns
- elderly
25
infectious agents
- the microorganisms (germ or bug) that can cause harmful infections and make you ill
- common infections in care homes are respiratory such as colds and flu and stomach bugs like norovirus and C. diff
- bacteria
- fungi
- viruses
- protozoa
26
ways to prevent infection through infectious agent
rapid accurate identification of organisms
27
ways to break the chain of infection: reservoir
- employee health
- environmental sanitation
- disinfection/sanitization
28
ways to break the chain of infection: portal of exit
- hand hygiene
- control of excretions and secretions
- trash and waste disposal
29
ways to break the chain of infection: means of transmission
- hand hygiene
- sterilization
- standard precautions
- airflow control
- food handling
- isolation
30
ways to break chain of infection: portal of entry
- aseptic technique
- catheter care
- wound care
31
ways to break the chain of infection: susceptible host
- treatment of underlying diseases
- recognition of high-risk patients
32
how does infection affect infants and young children
- may have a diminished response to an invading pathogen resulting in increased susceptibility to infection
33
how does infection affect older adults
- older adults with a diminished immune response may have a muted inflammatory response to infection
- may present with symptoms of dizziness, confusion, anorexia, and fatigue
- the presence of comorbidities (diabetes, cancer, kidney disease) may alter the body's response to infection
34
pathogen invasion
- bacteria release endotoxins or exotoxins, which damage the cells of the host and initiate an inflammatory response
- B lymphocytes are activated, resulting in the production of antibodies and memory cells
- T lymphocytes are activated, resulting in apoptosis
- complement system is activated to enhance the overall immune response
35
consequences of infection
- unresponsive or untreated infection
- compensation
- multisystem organ failure
36
What laboratory tests can help us diagnose infection?
- CBC with WBC differential
- culture and sensitivity
- ESR
- serological tests to detect specific antibodies or viruses
37
What does a culture and sensitivity test tell us?
it identifies the invading pathogen and determines the antimicrobial most likely to be effective in treatment
38
where are most culture and sensitivity tests drawn from?
- GU tract: urine culture
- respiratory tract: sputum culture
- oropharynx: throat culture
- blood
- wounds
- spinal fluid
39
What should always be done before starting IV antibiotics?
cultures!
40
primary prevention of infection
- infection control measures:
- hygiene
- standard precautions
- immunization
41
secondary prevention of infection
- opportunity to identify an infection for the purpose of early treatment and reduction of transmission
42
collaborative/tertiary prevention of infection
Goal:
- eradicate infection
- prevent secondary infections
- limit damage to the body
- Use of antimicrobials:
- antibiotics
- antivirals
- antifungal
- Nutrition
- Fluids
43
broad spectrum antibiotics
a wide variety of bacteria are sensitive
44
narrow spectrum antibiotics
only a few types of bacteria are sensitive
45
indications for prophylactic antibiotic use
- surgery
- sexually transmitted infection following exposure
- prosthetic heart valves prior to dental procedures
- recurring UTIs
46
principles in selecting an antibiotic
- identity of the causative organisms
- sensitivity of the infecting organism to an antimicrobial
- other factors: location of the infection, age, pregnancy status, allergies, and immune status
47
peaks and trough are monitored to...
to ensure effectiveness and prevent toxicity
48
what is a peak
- highest serum drug concentration
- drawn 30-60 minutes after medication administration
49
what is a trough
- lowest serum drug concentration
- drawn 30 minutes before next scheduled dose
50
key points to remember about ciprofloxacin
- teach clients to avoid sun exposure and wear protective clothing while outdoors
- report pain and swelling, and redness at the Achilles tendon to provider
- monitor for signs and symptoms of loose, frequent, foul smelling stool
51
key points about metronidazole
- teach clients it may cause a darkening of urine
- take medication with food to reduce adverse GI effects (nausea, vomiting, and dry mouth)
- instruct clients to call their provider if they experience headache, vertigo, and ataxia
- avoid alcohol when taking this medication
52
key points about penicillin
- educate clients to wear an allergy identification bracelet if allergic to this medication
- clients should take this medication with food to avoid GI upset
- monitor kidney function
- monitor client for 30 minutes after initial dose (IV or IM doses)
53
key points about erythromycin
- take the medication with food to lessen GI discomfort- nausea, vomiting, epigastric pain
- assess for cardiac rhythm abnormalities prior to administration
- educate client to report ringing in the ears, hearing loss, or vertigo
54
key points about vancomycin
- important to monitor peak and trough levels to avoid drug toxicity and nephrotoxicity
- monitor for signs of infusion reaction if the medication is infused too quickly
- assess IV site before, during, and after administration for signs of phlebitis
- report signs of tinnitus, vertigo, and hearing loss
55
key points about sulfamethoxazole
- monitor and report severe GI side effects
- may cause rare hypersensitivity reaction ---> Stevens-Johnson Syndrome
- instruct clients to drink at least 1250 mL of fluid while taking this medication
- client should report new fatigue, pallor, easy bruising, and any new infection
56
key points about acyclovir
- used for treatment of viral infections like herpes simplex and herpes zoster
- prevents viral DNA replication
- can be given oral, topical, or IV
- ensure IV assessment before, during, and after administration
57
key points about cefazolin
- similar in structure to penicillins
- contraindicated if client has had an anaphylactic reaction to penicillin
- monitor for watery or bloody diarrhea
- assess IV site for signs of phlebitis
58
key points about tetracycline
- may cause tooth discoloration- especially in young
- can cause GI discomfort and taking with meals (non-diary) is indicated if this occurs
- contraindicated in pregnancy
- instruct clients to wear protective clothing and use sunscreen when outdoors
- monitor for signs of jaundice
59
key points about aztreonam
- monitor IV site for redness, swelling, and pain
- use caution in clients with a known allergy to penicillin and cephalosporins
- can be given via inhalation
60
key points about gentamicin
- can cause ototoxicity when trough levels are elevated above expected range
- monitor for signs of nephrotoxicity
- encourage fluid intake
61
key points about meropenem
- use caution in client with a known allergy to penicillin and cephalosporins
- can cause GI upset- important to infuse at recommended rate
- monitor for signs of phlebitis
62
class and prototype of penicillin
Class: penicillin
Prototype: amoxicillin
63
What is the prototype of cephalosporins
cephalexin
64
what is the prototype of monobactums
aztreonam
65
what is the prototype of vancomycin
- vancomycin
- vancocin (brand name)
66
what is the prototype of macrolides
erythromycin
67
prototype of aminoglycosides
gentamicin
68
prototype of fluoroquinolones
ciprofloxacin
69
prototype of sulfonamides
sulfamethoxazole
70
prototype of acyclovir
- acyclovir
- Zovirax
71
urinary tract infection
caused by pathogenic microorganisms in the urinary tract, most commonly E. coli
72
lower urinary tract infection
infection involving the bladder or structures below the bladder
73
upper urinary tract infections
- infection involving the kidneys and ureters
- much less common but the most common cause of urosepsis
74
50% of all hospital acquired infections are....
CAUTIs
75
UTI risk factors
- female gender (shorter urethra = increased risk of bacteria invasion)
- diabetes
- pregnancy
- neurologic disorders
- gout
- altered states caused by incomplete emptying of the bladder and urinary stasis
- decreased natural host defenses or immunosuppression
- inability or failure to empty the bladder completely
- inflammation or abrasion of the urethral mucosa
- instrumentation of the urinary tract (catheterization, cystoscopic procedures)
- obstructed urinary flow caused by:
- congenital abnormalities
- urethral strictures
- contracture of the bladder neck
- bladder tumors
- calculi (stones) in the ureters or kidneys
- compression of the ureters
76
clinical manifestations of lower UTI
- burning on urination
- urinary frequency and urgency
- nocturia
- incontinence
- suprapubic, pelvic, and/or back pain
- hematuria
77
pyelonephritis
- bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys
- categorized as: acute or chronic
78
nclinical manifestations of acute pyelonephritis
- fever/chills
- increased WBCs
- tachycardia and tachypnea
- flank and/or lower back pain
- tenderness at the costovertebral angle (CVA)
- nausea and vomiting
- headache
- general malaise and fatigue
- burning, urgency, and frequency of urination
- nocturia
79
what results of a urinalysis indicate a client has a urinary tract infection
80
what results of a urinalysis indicate a client has a urinary tract infection
- positive leukocyte esterase: screening test used to detect a substance that suggests there are white blood cells in the urine
- nitrate
- WBC, RBC
- epithelial cells
81
diagnostics for acute pyelonephritis
- positive urinalysis for UTI
- blood cultures
- white blood cell count
- ESR/CRP
- BUN/Cr
- GFR
82
how do we prevent UTIs
- patient education
- shower rather than bathe
- wipe from front to back
- drink liberal amounts of fluids daily to flush out bacteria, may be helpful to drink 1 glass of cranberry juice a day
- avoid fluids that are urinary tract irritants (coffee, tea, alcohol)
- void every 2-3 hours and completely empty the bladder
- take medication exactly as prescribed
- notify PCP if symptoms persist
- consult primary provider regularly for follow up
83
how do we manage lower UTIs
- antibiotics
- relieve pain by: increasing fluid intake, avoiding urinary irritants, frequent voiding
- monitor for complications like urosepsis and AKI
- pt education
84
how do we manage acute pyelonephritis
- antibiotics
- analgesics
- antipyretics
- fluid therapy
85
what is the underlying patho of pneumonia
- inflammation of the lung tissue
- can be caused by bacteria, mycobacteria, fungi, and viruses
- interferes with the ability for the lungs to perform gas exchange
- can result in hypoxemia
86
risk factors for developing pneumonia
- smoking
- chronic lung disease
- immunosuppression
- prolonged immobility
- dysphagia/impaired cough reflex
- advanced age
- improper cleaning of respiratory equipment
- travel
- residence in a long-term care facility
87
community-acquired pneumonia (CAP)
pneumonia occurring in the community or less than or equal to 48 hours after hospital admission or institutionalization of patients who do not meet the criteria for health care associated pneumonia (HCAP)
88
health care-associated pneumonia (HCAP)
- pneumonia occurring in a nonhospitalized patient with extensive health care contact with one or more of the following:
- hospitalization for greater than 2 days in an acute care facility within 90 days of infection
- residence in a nursing home or long term care facility
- antibiotic therapy, chemotherapy, or wound care within 30 days of current infection
- hemodialysis treatment at a hospital or clinic
- home infusion therapy or home wound care
- family member with infection due to multidrug-resistant bacteria
89
hospital-acquired pneumonia (HAP)
pneumonia occurring greater than 48 hours after hospital admission that did not appear to be incubating at the time of admission
90
ventilator-associated pneumonia (VAP)
a type of HAP that develops greater than 48 hours after endotracheal tube intubation
91
What is aspiration pneumonia
- refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway
- most common form is bacterial infection from aspiration of bacteria that normally reside in the upper airways
- may occur in the hospital or community
- this type of aspiration or ingestion may impair lung defenses, cause inflammatory changes, and lead to bacterial growth and a resulting pneumonia
92
how do we prevent aspiration pneumonia
- texture modification of food
- positional swallowing maneuvers
- thickened liquids
- oral care
93
clinical manifestations of pneumonia
- increased respiratory rate
- dyspnea/orthopnea
- headache
- fever
- pleuritic chest pain
- malaise
- cough- purulent sputum
- breath sounds may be diminished, crackles, wheezing
94
how is pneumonia diagnosed
- chest x-ray
- sputum culture
- blood cultures
- CBC
- arterial blood gases
- bronchoscopy
95
treatment for pneumonia
- pharmacological therapy:
- antibiotic therapy
- antipyretic therapy
- anti-tussive
- O2 therapy
- adequate hydration
96
nursing interventions for pneumonia
- promoting rest and conserving energy
- promoting fluid intake
- maintaining nutrition
- monitoring and managing potential complications
97
potential complications of pneumonia
- hypotension
- septic shock
- respiratory failure
- pleural effusion
98
how do we prevent pneumonia
- pneumococcal conjugate and pneumococcal polysaccharide vaccines
- receive annual influenza vaccine
- proper hand hygiene
- clean all respiratory equipment frequently
- smoking cessation
- adequate rest/health balanced diet
- adequate hydration
99
what is viral hepatitis
- systemic, vial infection characterized by necrosis and inflammation of liver cells
- 5 types: Hepatitis A, B, C, D, E
100
general s/s of hepatitis
- abdominal pain (enlarged liver)
- yellowish sclera ---> icterus
- arthralgia or myalgia
- diarrhea/constipation
- jaundice
- light clay-colored stools
- dark yellow to brownish urine
- fever
- fatigue/malaise
- anorexia/nausea/vomiting
- dry skin and pruritis
101
how is hepatitis diagnosed
- elevation in liver enzymes (ALT, AST, alkaline phosphatase)
- presence of antibodies
- presence of surface antibodies
- liver biopsy
102
how is hepatitis A transmitted?
fecal-oral route
103
risk factors for hepatitis A
- poor hand hygiene
- infected food handler
- consuming water or shellfish
104
how can hepatitis A be prevented
- vaccination
- proper handwashing
- avoiding contaminated food or water
- proper control of sewage disposal
- receiving immunoglobulin within 14 days of exposure
105
how is hepatitis B transmitted
sexual contact, blood-borne, maternal-neonatal
106
risk factors for hepatitis B
- close contact with carrier of hep B
- frequent exposure to blood, blood products, or other bodily fluids
- hemodialysis
- IV/injection drug use
- gay men and bisexual activity
- mother to child transmission
- multiple sexual partners
107
how to prevent hepatitis B
- prevention of transmission
- vaccination (also protects against HDV)
- hepatitis B immunoglobulin
- advise avoidance of high risk behaviors
- monitor cleaning, disinfections, and sterilization of reusable devices in patient care settings
108
how is hepatitis C transmitted
- blood to blood
- sexual
109
risk factors for hepatitis C
- children born to women infected with hepatitis C
- healthcare and public safety workers after needlestick injuries or mucosal exposure to blood
- multiple contacts with a person who is infected with hepatitis C virus
- multiple sex partners, history of sexually transmitted infection, unprotected sex
- past/current illicit IV/injection drug use
110
how is hepatitis C prevented
- advise avoidance of high-risk behaviors such as IV drug use
- avoid multidose vials in patient care settings
- monitor cleaning, disinfection, sterilization of reusable devices in patient care settings
- use barrier precautions in situations of contact with blood or body fluids
- use needleless IV and injection systems in healthcare
- use standard precautions in clinical care
111
how is hepatitis D transmitted
- parenteral and sexual
- ONLY OCCURS WITH CONCURRENT HEP B INFECTION
112
hepatitis D risk factors
- injection drug users
- persons with hemophilia
- household contacts of chronically infected persons
113
how is hepatitis D prevented
- receive Hep B vaccine
114
how is hepatitis E transmitted
fecal-oral route
115
how is hepatitis E prevented
- avoiding contaminated food or water
- hand hygiene
116
general management of hepatitis
- promote nutrition
- high in carbohydrates and calories
- small, frequent meals
- avoid alcohol
- encourage periods of rest
- avoid over the counter medications/herbal supplements
- antiviral medications
117
proliferation
- cellular replication
- mitosis: duplication
- meiosis: sexual reproduction
118
differentiation
- happens when a cell acquires functions that are different from those of the original cell from which it derived
- normal process
119
benign neoplasm
- non cancerous tumor
- tend to retain most of the morphologic and functional characteristics of the normal cell but represent groups of abnormal cells with excess growth
- capable of replication and mitosis
- not capable of metastasis
ex. endometriosis, nevi, hypertrophic scars
120
malignant neoplasm
- cancerous tumor
- characterized by cells having abnormal growth patterns, multiple abnormal functions, and the ability to disseminate to distant sites
- complex tissues composed of many distinct cell types
121
grading of neoplasms
- the measure of the degree of differentiation of a neoplasm
122
staging of neoplasms
- the TNM staging system is used to determine the stage of the disease
- assesses the growth and spread of the tumor based on 3 factors::
- tumor size and invasiveness
- the presence or absence of of spread to regional lymph nodes
- the presence or absence of metastasis to distant organs
123
Risk factors for Cancer development
- racial and ethnic minorities
- poverty
- age
- smoking and tobacco
- infectious agents
- genetic risk
- radiation
- carcinogens
- nutrition and physical activity
124
warning signs of cancer- CAUTION
C- change in bowel or bladder habits
A- a sore throat that does not heal
U- unusual bleeding or discharge
T- thickening or lump in breast or elsewhere
I- indigestion or dysphagia
O- obvious change in wart or mole
N- nagging cough or hoarseness
125
primary prevention of cancer
- preventing cancer from occuring
- eliminating risk factors:
- behavioral modification
- modification of the environment
- vaccination
- treatment of infection
- prophylactic surgery
126
secondary prevention of cancer
- goal is early disease detection so prompt treatment can be initiated
- Screening:
- colonoscopy
- mammogram
- prostate specific antigen
- self exams for breasts and testicles
127
tertiary prevention of cancer
- cure, control, palliation
- surgery: can be preventative/prophylactic, diagnostic, curative, palliative, reconstructive
- radiation therapy: may be delivered with external beam therapy or brachytherapy
- chemotherapy
- hormonal therapy
- targeted therapy
- biologic therapy
- bone marrow and hematopoietic stem cell transplantation
128
what is normal WBC count
5000-10000
129
What absolute neutrophil counts put you at risk for infection?
- ANC < 1500/mm3 = risk of infection rises
- ANC <500/mm3 = severe risk of infection
130
normal hemoglobin levels
females: 12-16 g/dL
males: 14-18 g/dL
131
normal platelet ranges
150000- 400000/mm3
132
thrombocytopenia
platelet count < 100000/mm3
- increased risk of bleeding = platelet count <50000/mm3
- increased risk of spontaneous bleeding = platelet count < 10000/mm3
133
what are the two types of radiation
- external beam radiation therapy (EBRT)
- brachytherapy
134
local side effects of radiation
- altered skin integrity
- alopecia
- radiodermatitis
- stomatitis/mucositis
135
systemic side effects of radiation
- fatigue
- malaise
- anorexia
136
toxic effects of chemotherapy on body systems
- GI: nausea and vomiting
- hematopoietic system: myelosuppression at nadir of treatment
- Renal: acute kidney injury
- cardiopulmonary: cardio and pulmonary toxicity
- reproductive: infertility
- neurologic system: chemotherapy induced neurotoxicity
- cognitive impairment
- fatigue
137
neutropenia
abnormally low ANC
138
what type of education should be prioritized in a client with cancer
nutrition
139
what is the role that protein plays in our body
- tissue building and maintenance
- balance of nitrogen and water
- backup energy
- support of the immune system
- facilitating acid-base and fluid/electrolyte balance
- formation of neurotransmitters, enzymes, antibodies, breast milk, mucus, histamine, and sperm
140
why do we need protein
- tissue growth needs
- quality of the dietary protein
- added needs due to illness
141
how can people with cancer increase their protein
- substitute whole milk for water
- add milk, cheese, yogurt, or ice cream to dishes
- use peanut butter and yogurt as toppings
- dip meats in eggs, milk, and breadcrumbs before cooking
142
nursing interventions to ease pain and discomfort of cancer
- assessment of pain and management strategies
- collaborate with patient and healthcare team members to make changes to pain management plan as needed
- consult palliative care
- explore non-pharmacologic and complementary strategies
143
nursing interventions to decrease fatigue and activity intolerance in cancer
- encourage a balance of rest and exercise
- promote patient's normal sleep habits
- ask for help
- encourage participation in planned exercise programs
- collaborate with physical and occupational therapy
144
nursing interventions for managing anxiety and grief related to cancer
- therapeutic communication
- encourage verbalization of fears, concerns, and questions
- explore coping strategies
- involve spiritual advisor or encourage professional counseling
145
breast cancer risk factors
- risk increases with age
- genetics
- non hispanic african american women
- non hispanic caucasian women
- family history
- female genfer
- obesity
- alcohol intake
146
breast cancer prevention for high-risk patients
- long- term surveillance --> focus on early detection
- chemoprevention
- prophylactic mastectomy
147
what are the different types of breast cancer surgeries
- modified radical mastectomy
- total (simple) mastectomy
- breast conservation treatment
148
potential complications of breast cancer surgery
- lymphedema
- hematoma or seroma
- infection
- changes in sexual function
149
pt education/nursing care for radiation for breast cancer
- external beam radiation:
- anatomic areas to be treated are mapped out and identified with permanent ink markings
- treatment lasts a few minutes and is given 5 days a week for 5-6 weeks
- brachytherapy:
- radiation is delivered by an internal device
- treatment given over 4-5 days
150
pt education/nursing care for chemotherapy in breast cancer
- done after surgery but before radiation
- common complications:
- nausea and vomiting
- myelosuppression
- taste changes
- alopecia
- mucositis
- neuropathy
- fatigue
151
leukocytosis
increase in WBC in the circulation
152
what is leukemia?
- uncontrolled proliferation of WBCs, often immature
- this proliferation leads to an overcrowding in the bone marrow resulting in impaired hematopoietic cell function and can affect other organs in the body
153
how is leukemia classified?
- acute vs. chronic
- lymphoid vs. myeloid
154
acute myeloid leukemia risk factors
- development of abnormal blast cells (immature leukocytes) that crown normal bone marrow
- results in anemia, thrombocytopenia, and abnormal WBC
155
clinical manifestations of AML
- anemia
- neutropenia
- thrombocytopenia
- pain from enlarged liver or spleen
- hyperplasia of gums
- bone pain
156
induction phase of treatment AML
- destruction of leukemic and healthy cells
- client is typically very ill which = infections, bleeding, and severe mucositis
- administration of blood products and treatment of infections
157
consolidation phase of AML treatment
- given to eliminate any residual leukemic cells and reduce chance of reccurance
158
chronic myeloid leukemia
- arises from a chromosomal mutation in the myeloid stem cell
- three phases of CML: chronic, accelerated, blast crisis
159
What is a shift to the left?
significant number of baby neutrophils/bands are present
160
how is CML managed
- goal is to control the disease- remission or remailing in chronic stage
- tyrosine kinases inhibitors (TKIs)
- allogenic bone marrow transplant
161
acute lymphocytic leukemia
- results from uncontrolled proliferation of immature cells from the lymphoid stem cell
- cases are mostly in children
162
clinical manifestations of ALL
- often found incidentally with routine testing
- enlarged liver and spleen = pain
- bone pain
- central nervous system ---> cranial nerve palsies, headache, vomiting
163
treatments for ALL
- based on genetic markers of the disease along with individual risk factors and age
- use of corticosteroids is seen often during induction phase
164
chronic lymphocytic leukemia
- common malignancy in older adults (ex. veterans of Vietnam war)
- derived from a malignant clone of B lymphocytes ---> most leukemic cells are fully mature
165
complications of CLL
- autoimmune
- risk for developing other cancers
- infections
166
clinical manifestations of CLL
- lymphocytosis
- lymphadenopathy
- splenomegaly
167
how is CLL managed
- if asymptomatic at the time of diagnosed: watch and wait
- management is based on:
- clinical stage of the disease
- symptoms
- functional status of patient ---> life expectancy, ability to tolerate therapy, ability to perform ADLs
- genetic risk
- efficacy of prior treatment
