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2.0 Adult Nursing Exam 4 > Hematologic part 2 > Flashcards

Hematologic part 2 Flashcards

1
Q

What is the difference between acute myeloid leukemia and chronic myeloid leukemia?

A

Instead of having a blast issue, there’s a Philadelphia chromosome section missing.

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2
Q

Explain the Philadelphia chromosome issue with Chronic Myeloid Leukemia or CML.

A

The section known as Philadelphia chromosome will be missing from #22 and put on #9 - and fused to crease rapid division of leukocytes or wbcs due to an abnormal protein that was formed.

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3
Q

What is the name of the protein that causes wbc division in Chronic myeloid leukemia?

A

tyrosine kinase protein

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4
Q

What portion of the #22 was taken?
Where was it put specifically?

A

BCR - breakpoint cluster
It was put on the ABL viral of #9.

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5
Q

Who does CML typically happen to?

A

Its uncommon in people younger than 20, so usually older. Like 67 old.

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6
Q

What are the phases of Chronic Myeloid Leukemia?

A

Chronic > Transformation > Acute form

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7
Q

What is chronic CML like?

A

Very few symptoms. Very subtle.

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8
Q

What is the transformation phase of CML?
What might they start to notice sypmtom wise?

A

It’s when the chronic form of the myeloid leukemia is transforming into the acute form.

Symptoms of bone pain, fevers, and weight loss.

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9
Q

What is the Acute phase of CML?

Since they are in this phase, what are they likely to die from?

A

Well at this point the CML is no longer chronic. It’s transformed into AML and they are at a blast crisis.

They can die from bleeding and infection due to the Pancytopenia.

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10
Q

When the CML is still in the chronic phase, what are the treatment options?

A

Gleevec
Add on another dose of the Gleevec
Add another inhibitor
Bone marrow transplant (BMT)

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11
Q

What does Gleevec do to stop the CML?

A

Inhibits the tyrosine kinase protein that started the leukocyte issue by blocking the signal to divide.

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12
Q

What do patients need to avoid when taking Gleevec so that they don’t ruin absorption?

A

Antacids
Grapefruit juice

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13
Q

What is treatment like for CML that phases into the AML?

A

Follow treatment for AML.
Induction > Consolidation, BMT.

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14
Q

You are giving your CML patient Gleevec PO. What do you need to before opening the medication?

A

Gloves to protect yourself.

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15
Q

How long does a patient have to be in remission for to be considered cured?

A

At least 5 years

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16
Q

During remission, what do patients need to do?

A

Continue to do check ups.

17
Q

Does everyone qualify for BMT?

A

Nope.
Should probably be under the age of 65 and otherwise healthy. But, it’s not a hard rule.

18
Q

What is Acute Lymphocytic Leukemia?

A

Proliferation or replication of immature lymphoid stem cells that we call lymphoblasts which causes the pancytopenia.

19
Q

What age will we not see Acute Lymphocytic Leukemia in?

A

We won’t see ALL in middle aged adults. It is common in those under 15 and also common in those above 50.

20
Q

When we say the Acute Lymphocytic Leukemia causes pancytopenia, what are we referring to?

A

The ALL impedes on the growth of our myeloid cells like rbcs, wbcs, and platelets.

21
Q

What do patients with pancytopenia look like again?

A

Anemic, bruising, petechiae, cold. - remember they are at a bleeding risk fyi.

22
Q

In Acute lymphocytic leukemia, where do we generally see it travel to?

Where else will it go?

A

Liver & Spleen

Bones
CNS

23
Q

We generally don’t see infiltration of leukemia cells into other organs and areas of the body with Acute Lymphocytic Leukemia.

True or false?

A

False.

ALL infiltration into other organs is the most common.

24
Q

When you assess a patient and are trying to discover if there’s any infiltration of the liver, spleen, bones, etc. What will you be looking for?

A

Liver/spleen infiltration may have tenderness and rebound pain

Bone pain which may be mistaken for just being old.

25
Q

How do we decrease the CNS infiltration in Acute Lymphocytic Leukemia?

A

Prophylactic cranial irradiation or intrathecal chemo

26
Q

What is the expected outcome of ALL?

A

Remission but that doesn’t always happen. But the ones with other health probelms may not

27
Q

What are lymphoid blast cells sensitive to during induction?

A

Corticosteroids

Vinca alkaloids

28
Q

What is treatment like for Acute Lymphocytic Leukemia?

A

Induction > Testing for residual leukemia > then Consolidation

  • can go back to induction if there is a relapse and include Hemo stem cell transplant
29
Q

How long is Consolidation for ALL?

A

3 years

30
Q

When do we start counting years for remission?

A

We start counting years after consolidation - remember 5 years at least is required.

31
Q

What is ALL patients relapse?

A

Induction therapy is done. Then they can do HSCT or hemo stem cell transplant.

32
Q

What is Chronic Lymphocytic Leukemia?

A

Cloning of mature & malignant B lymphocytes because they were able to escape apoptosis.

33
Q

Avg age of onset for Chronic Lymphocytic Leukemia?

A

72 years old

34
Q

Where do the the leukocytes get trapped in with Chronic Lymphocytic Leukemia?

What does it cause?

And where do you assess?

Where does it spread?

A

They get trapped in lymph nodes which causes enlarged nodes that are sometimes painful.

Check clavicular chain

Spreads to the liver and spleen

35
Q

What is Immunophenotryping?

A

A work up to figure out the best treatment for the patients.

36
Q

What can develop in the later stages of Chronic Lymphocytic Leukemia?

A

Anemia

Thrombocytopenia

  • both related to autoimmune response
37
Q

What presentation do those with Chronic Lymphocytic Leukemia show?

What about later on?

A

Often no symptoms or the type that go unnoticed or mistaken for something else. Found on physical bc of lymph nodes tho.

Later on can have B symptoms of fever, sweating at night, and weight loss. Often mistaken for flu.

38
Q

What are those with chronic lymphoytic leukemia at risk for?

What does the treatment put them at risk for?

A

Infection risk already

With treatment, risk for bone marrow suppression and more infection.

39
Q

What supportive medications will they use for those with Chronic Lymphocytic Leukemia? And for how long?

A

Antivirals and Antibiotics

They will use these for months after treatment to make sure to protect form infection.

2.0 Adult Nursing Exam 4 (8 decks)

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