Leukemia

Question 1

What is leukemia?

Answer 1

Blood cancer that results from a loss of normal cellular regulation leading to uncontrolled production of immature WBCs in bone marrow

Question 2

What can leukemia progress to?

Answer 2

myelodyplastic syndromes (MDs) = all patients have a decrease in all circulating blood cell types

Question 3

What does leukemia lead to?

Answer 3

Anemia, thrombocytopenia, leukopenia

Question 4

How is leukemia classified?

Answer 4

By cell types
-lymphocytic
-myelocytic
-biphenotypic leukemia (both types combined)

Question 5

What is acute leukemia?

Answer 5

Sudden onset, rapid growing, more severe symptoms, bone marrow produces immature WBCs
-needs immeidate tx

Question 6

What is chronic leukemia?

Answer 6

Slow onset, persists for months to years
-slow growing, usually milder symptoms
-bone marrow produces more mature cells (not fully developed)
-may not require immediate tx

Question 7

What puts someone at risk for leukemia?

Answer 7

radiation, viral infection, exposure to chemicals & drugs, genetic factors, immunity factors

Question 8

What assessment history do you need to gather?

Answer 8

RF
genetic factors
age
occupation
hobbies
medical hx- medications & radiations
infections
bleeding issues
weakness
fatigue

Question 9

What does leukemia affect?

Answer 9

All organs and systems

Question 10

How does it impact the CV system?

Answer 10

tachycardia
HYPOtension
slow capillary refill
murmurs
bruits
**HYPO and tachy due to anemia since the blood is thin so not a lot of O2 = decreased perfusion

Question 11

What happens when WBC is high?

Answer 11

blood is THICCCK = HYPERtension with bounding pulses

Question 12

How does it impact the respiratory system?

Answer 12

tachypnea
infiltrates
respiratory infection

Question 13

What are the signs of respiratory infection?

Answer 13

cough
dyspnea
abnormal breath sounds

Question 14

How does it impact the integumentary system?

Answer 14

pallor
cool
petechiae
poor healing wounds
bleeding gums

Question 15

How does it impact the GI/GU system?

Answer 15

weight loss
nausea
anorexia
rectal & GI bleeding
decreased bowel sounds
liver enlargement
spleen enlargement
aBdominal pain/tenderness
hematuria

Question 16

How does it impact the CNS?

Answer 16

cranial nerve changes
headache
seizure
papilledema
coma
fatigue
fever
behavior changes
somnolence
reduced attention

Question 17

How does it impact the MS?

Answer 17

bone pain
joint swelling & pain
muscle weakness

Question 18

What types of patients have a poorer prognosis?

Answer 18

Patients with a high immature WBC count at diagnosis

Question 19

Whats another sign of leukemia?

Answer 19

lymph node enlargement

Question 20

How do the labs appear?

Answer 20

Hemoglobin & hematocrit = low
platelet count = low
WBC= low, normal or high
reduced level of clotting factor
aPTT = prolonged
thrombocytopenia

Question 21

Normal hematocrit

Question 22

Normal hemoglobin

Question 23

Normal platelet count

Question 24

Normal WBCs

Question 25

How to diagnosis leukemia?

Answer 25

bone marrow aspiration & biopsy chromosome analysis (cytogenic studies) imaging- x-ray/ bone density

Question 26

Interventions for infection

Answer 26

infection prevention drug therapy for infection antibiotic prophylaxis pulmonary hygiene specialized unit handwashing aesptic technique skin care ensure those who enter the room are not sick neutropenic precautions

Question 27

What needs to be assessed to make sure no infection and sepsis?

Answer 27

-CBC with diff - WBC, Absolute neutrophils -respiratory assessment -assess urination & urine -VS with temp

Question 28

What are the 3 distinct phases of drug therapy for acute leukemia?

Answer 28

induction, consolidation, maintenance

Question 29

What happens during induction?

Answer 29

combo chemo- 7 plus 3

Question 30

What are the complications that can occur during induction?

Answer 30

infection, kidney/liver/cardiac toxicity, NVD, stomatitis, alopecia

Question 31

What is more common during the induction phase?

Answer 31

infection related deaths

Question 32

What happens during the consolidation phase?

Answer 32

another round of chemo -occurs only in remission

Question 33

What happens during the maintenance phase?

Answer 33

months to years after induction & consolidation

Question 34

What is first line drug therapy for chronic leukemia?

Answer 34

Imatiruib mesylate (Gleevac)