Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Unit 4 > Leukemia > Flashcards

Leukemia Flashcards

(68 cards)

Start Studying
1
Q

Leukemia

A

type of cancer with uncontrolled production of immature WBCs; bone marrow becomes overcrowded with immature nonfunctional cells and production of normal blood cells is greatly decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lymphocytic/lymphoblastic cells

A

leukemic cells coming from the lymphoid pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Myelocytic/myelogenous cells

A

abnormal cells coming from the myeloid pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Biphenotypic leukemia

A

acute leukemia that shows both lymphocytic and myelocytic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Possible risk factors for leukemia

A

ionizing radiation, viral infection, exposure to chemicals and drugs, bone marrow hypoplasia, genetic factors, immunologic factors, environmental factors, and interaction of these factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute myelogenous leukemia (AML)

A

most common form of leukemia; diagnosed and classified on the basis of the number of healthy blood cells, the number of leukemic cells, and the specific chromosomal abnormalities identified in the leukemic cells; prognosis varies by subtype and chromosomal abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute promyelocytic leukemia (APL)

A

common sub-type of adult onset AML; most curable of the adult AMLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute lymphocytic leukemia (ALL)

A

most common in children; in adults, the Philadelphia chromosome (hallmark of chronic myelogenous leukemia) may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chronic myelogenous leukemia (CML)

A

occurs more often in people older than 50; presence of the Philadelphia chromosome abnormality in the leukemic cells; has 3 phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic phase of CML

A

slowly progressing course; pt may have mild symptoms and respond to standard treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Accelerated phase of CML

A

spleen enlargement and progressive manifestation such as intermittent fevers, night sweats, and unexplained weight loss; lasts 6-12 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Blast phase of CML

A

indicates transformation to a very aggressive acute leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chronic lymphocytic leukemia (CLL)

A

most common type of chronic leukemia; occurs most in people over 50; survival time ranges from less than 19 mos to more than 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Leukemia history assessment

A

exposure to risk factors and genetic factors; occupation and hobbies; previous illnesses and med history; changes in immune function; excessive bleeding episodes; weakness and fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Integumentary manifestations of leukemia

A

ecchymoses, petechiae, open infected lesions, pallor of the conjunctivae, nail beds, palmar creases, and around the mouth, decreased tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gastrointestinal manifestations of leukemia

A

bleeding gums, anorexia, weight loss, enlarged liver and spleen, constipation, decreased peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Renal manifestations of leukemia

A

hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cardiovascular manifestations of leukemia

A

tachycardia at basal activity, orthostatic hypotension, palpitations, murmurs, bruits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Respiratory manifestations of leukemia

A

tachypnea, dyspnea on exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Neurologic manifestations of leukemia

A

fatigue, headache, fever, cranial nerve problems, papilledema, seizures, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Musculoskeletal manifestations of leukemia

A

bone pain, joint swelling and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Psychosocial manifestations of leukemia

A

anxious and fearful; spend time with pt and family; learn pts expectations and feelings; assess coping patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bone marrow aspiration and biopsy

A

definitive test for leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lab values of leukemia

A

abnormal WBC; decreased Hgb, Hct, platelets; abnormal clotting times and factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Autocontamination
source of infection; normal flora overgrows and penetrates the internal environment
26
Cross contamination
source of infection; organisms from another person or the environment are transmitted to the pt
27
Induction therapy (acute leukemia)
combination chemotherapy started at the time of diagnosis; purpose is to achieve rapid, complete remission of all manifestations; side effect is severe bone marrow suppression with neutropenia; recovery of bone marrow function requires 2-3 wks; protect from life threatening infections
28
Consolidation therapy (acute leukemia)
another course of either the same drugs used for induction at a different dosage or a different combination of chemo drugs; intent is to cure; may be either single course or repeated courses of chemo; hematopoietic stem cell transplantation also may be considered
29
Maintenance therapy (acute leukemia)
may be prescribed for months to years after successful induction and consolidation therapies; used for ALL and APL; purpose is to maintain remission achieved; maintenance drugs for ALL are milder; given orally for 2-5 yrs
30
Treatment of chronic lymphocytic leukemia
standard chemotherapy; can cause remissions but does not cure; hematopoietic stem cell transplantation; curative potential or prolonged disease-free survival; comes with risk of mortality
31
Drug therapy for infection
antibiotic and antibacterial drugs (aminoglycoside antibiotic, penicillin, third gen cephalosporin, vancomycin for MRSA), systemic antifungal drugs (recommended when neutropenic pt remains febrile 4-7 days after abx therapy), antiviral drugs (acyclovir)
32
Antiviral drugs
used in pts with leukemia to prevent and treat viral infection; have serious side effects including ototoxicity and nephrotoxicity; monitor for hearing and kidney function impairment
33
Protection from infection
extreme care during nursing procedures; no ill visitors/caregivers in room; strict asepsis; private room; no standing water; HEPA filtration; continually assess pt for infection; CBC daily; ANC daily; inspect mouth every shift; assess lungs for crackles; assess urine and urgency burning or pain with urination; VS Q4 hrs; obtain lab specimens as ordered; good hygiene; turn immobile pt hourly; apply skin lubricants; pulmonary hygiene Q4 hrs; cough and deep breathe hourly; neutropenic diet
34
Hematopoietic stem cell transplantation
standard treatment; must have closely matched donor and be in temp remission after induction therapy; additional chemo given to purge the marrow of leukemic cells; new healthy stem cells are given to pt
35
Allogenic bone marrow transplantation
transplantation of bone marrow from a sibling or matched unrelated donor
36
Autologous transplantation
transplantation of pt receives their own stem cells collected before high-dose chemo
37
Synergeneic
transplantation of identical sibling
38
Phases of transplantation
obtainment and conditioning, transplantation, engraftment, and post-transplantation recovery
39
Obtaining stem cells
bone marrow harvesting, peripheral blood stem cell harvesting, cord blood harvesting
40
Bone marrow harvesting
marrow is removed through multiple aspirations from iliac crests; 500-1000 mL aspirated; filtered; treated to rid the marrow of any remaining cancer cells; allogeneic marrow is transfused immediately; autologous marrow is frozen for later use
41
Pt care following harvest
monitor donor for manifestations of fluid loss; assess for complications of anesthesia; manage pain; hydrate with saline infusions before and after surgery; may need RBC transfusion; assess harvest sites for bleeding; analgesics
42
Peripheral blood stem cell harvesting
three phases: mobilization, collection by pheresis, reinfusion; PBSCs are stem cells that have been released from the bone marrow and circulate within the blood
43
PBSC mobilization phase
chemo or hematopoietic growth factors are given to pt; agents increase the numbers of stem cells and WBCs in peripheral blood
44
PBSC pheresis phase
withdraw whole blood, filtering out the cells, and returning the plasma to the pt; 1-5 pheresis procedures are needed to obtain enough stem cells for transplant; cells are frozen and stored for reinfusion after regiment is complete; monitor for catheter clotting and hypocalcemia; monitor VS hourly during for hypotension;
45
PBSC cord blood harvesting
obtaining stem cells form umbilical cord blood of newborns; high concentration of stem cells; drawn from umbilical vein following delivery and is stored in liquid nitrogen
46
Conditioning regimen
"wipes out" the pts own bone marrow; gives higher than normal doses of chemo and/or radiotherapy to rid the person of cancer cells; 5-10 days is required
47
Conditioning: days T-5 through T-4
high dose chemotherapy to obliterate the pts bone marrow cells and to kill of any remaining leukemic cells; dosages are much higher than normal chemo
48
Conditioning: days T-3 through T-1
delivery of TBI (total body irradiation); 200 rads twice daily over 3 days; pt has all the expected side effects associated with chemo and radiation
49
Late effects from conditioning regimen
can occur as late as 3-10 years after transplantation; include veno-occlusive disease, skin toxicities cataracts, lung fibrosis, second cancers, cardiomyopathy, endocrine complications, neurologic complications
50
Transplantation
day T-0; marrow, PBSCs, or umbilical cord blood cells are thawed and infused through the pts central catheter
51
Side effects of stem cell transfusions
fever, hypertension, red urine; administer acetaminophen and diphenhydramine before infusion; administer antihypertensives or diuretics to treat fluid volume changes
52
Engraftment
PBSCs and marrow cells circulate briefly in the peripheral blood; stem cells find their way to the marrow-forming sites of the pts bones; stem cells must survive and grow in the pts bone marrow sites; takes 8-12 days for peripheral blood stem cell transplantation and 12-28 days for bone marrow stem cell transplantation; growth factors may be given; when engraftment occurs, WBC, RBC, and platelet counts begin to rise
53
Engraftment monitoring
check pts blood for chimerism (presence of blood cells that show genetic profile or other marker that is different from those of the pt; progressive chimerism with increasing percentages of donor cells indicates engraftment
54
Prevention of complications during transplantation
infection and bleeding precautions; help pt maintain hope, positive attitude and be involved in recovery
55
Failure to engraft
donated stem cells fail to grow in the bone marrow and function properly; pt will die unless another transplant with stem cells is successful
56
Graft-versus-host disease (GVHD)
immunocompetent cells of the donated marrow recognize the pts cells, tissues, and organs as foreign and start an immunologic attack against them; graft is attacking the host; presence of some GVHD indicates successful engraftment
57
Management of GVHD
limit activity of donor T-cells by using drugs to suppress immune function
58
Veno-occlusive disease (VOD)
blockage of liver blood vessels by clotting and inflammation; usually begins within the first 30 days following transplantation; manifestations include jaundice, pain in RUQ, ascites, weight gain, liver enlargement
59
Management of VOD
supportive treatment only; early detection improves chance of survival; fluid management is crucial; assess daily for weight gain, fluid retention, increases in abd girth, and hepatomegaly
60
Thrombocytopenia in AML
normal bone marrow production of platelets is limited; pt at great risk for excessive bleeding; can also be caused by induction therapy or high-dose chemo for transplantation; at extreme risk for bleeding at 50,000 and spontaneous bleeding at 20,000
61
Management of thrombocytopenia
bleeding precautions; assess Q4 for bleeding, oozing, enlarging bruises, petechiae, or purpura; inspect stools, urine, drainage, and vomit for blood and measure accurately; measure abd girth daily; monitor lab values daily
62
Bleeding precautions
handle pt gently; use lift sheet; avoid IM and venipunctures, use smallest gauge needle possible if unavoidable; apply firm pressure to any punctures for 10 minutes; apply ice to areas of trauma; test urine and stool for occult blood; observe IV sites Q2; avoid rectal trauma; measure abd girth daily; teach oral care; do not blow nose; avoid contact sports; wear shoes with firm soles when ambulating
63
Conserve energy and improve RBC counts
nutrition therapy, blood transfusions, drug therapy, activity management
64
Nutrition therapy
provide small frequent meals high in protein and carbs
65
Drug therapy
colony-stimulating growth factors or erythropoiesis-stimulating agents for anemia and neutropenia; assess for side effects such as hypertension, headaches, fever, myalgia, and rashes
66
Activity management
conserve pts energy; space care activities at least an hour apart and when pt has most energy
67
Home care
visiting nurse for dressing changes and home transfusion therapy and chemotherapy; will spend 4-8 hrs per day in the home
68
Pt teaching for self management
importance of continuing therapy and follow up; teach about infection prevention; teach safety and bleeding precautions

Unit 4 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions