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Medical Surgical Exam 4 > Leukemia > Flashcards

Leukemia Flashcards

(44 cards)

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1
Q

What is Leukemia?

A

A group of malignant disorders affecting the blood and
blood-forming tissues of

  • Bone marrow
  • Lymph system
  • Spleen
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2
Q

At what age does Leukemia occur?

A

Occurs in all age groups

Thought of as a childhood disease
Number of adults affected is actually 9 times that of children

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3
Q

How does Leukemia occur?

A

Accumulation of dysfunctional cells due to loss of regulation in cell division

Fatal if untreated

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4
Q

What is the cause of Leukemia?

A

No single cause
Combination of genetic and environmental influences

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5
Q

PAthophysiology of Leukemia picture

A
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6
Q

Classification of Leukemia

A

Acute versus Chronic

Based on type of WBC

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7
Q

Acute Leukemia

A

Acute: Clonal proliferation of immature hematopoietic cells

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8
Q

Chronic Leukemia

A

Chronic: Mature forms of WBC and onset is more gradual

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9
Q

Types of acute Leukemia

A

Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
Also called acute nonlymphoblastic leukemia (ANLL)

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10
Q

Types of Chronic Leukemia

A

Chronic myelogenous leukemia (CML)
Chronic lymphocytic leukemia (CLL)

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11
Q

Acute Myelogenous Leukemia (AML)

A

Abrupt, dramatic onset
Serious infection or abnormal bleeding
Uncontrolled proliferation of myeloblasts
Hyperplasia of bone marrow and spleen

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12
Q

Acute Lymphocytic Leukemia (ALL)

A

Most common type of leukemia in children
20% of acute leukemia in adults
Immature, small lymphocytes proliferate in the bone marrow-in children usually

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13
Q

Acute Lymphocytic Leukemia (ALL) S/S

A

Signs and symptoms may appear
Abruptly
Fever
Bleeding
Insidiously
Progressive weakness, fatigue, pain, bleeding tendencies
CNS manifestations are common-leukemic meningitis

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14
Q

Chronic Myelogenous Leukemia (CML)

A

Excessive mature neoplastic granulocytes in bone marrow
Move into peripheral blood in massive numbers
Ultimately infiltrate liver and spleen

_Philadelphia chromosome-
Diagnostic hallmark
Present in >90% to 95% CML patients_
Chronic, stable phase
Followed by acute, aggressive phase

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15
Q

Chronic Lymphocytic Leukemia (CLL)

A

Most common leukemia in adults
Production and accumulation of functionally inactive but long-lived, mature-appearing lymphocytes
B cell involvement
Lymphadenopathy is present throughout body

Complications from early-stage CLL are rare
May develop as disease advances
Pain, paralysis from pressure caused by enlarged lymph nodes

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16
Q

Leukemia Clinical Manifestations

A

Varied but usually related to
*Bone marrow failure
Overcrowding by abnormal cells-trouble with inadequate production of healthy cells
Inadequate production of normal marrow elements
Formation of leukemic infiltrates*

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17
Q

Leukemia Clinical Manifestations

Inadequate marrow elements cause

A

Anemia
Thrombocytopenia
Low to high number and altered function of WBCs

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18
Q

What happens as Leukemia progresses

Study These Flashcards
A

, fewer blood cells are produced
Abnormal WBCs continue to accumulate
Leukemic cells may infiltrate organs

19
Q

Leukemic cells may infiltrate organs and lead to

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A

Splenomegaly
Hepatomegaly

20
Q

Leukemic cells may cause

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A

Lymphadenopathy- enlarged lymphnodes
Bone pain
Meningeal irritation
Oral lesions
Solid masses (chloromas)- Collection of leukemic cells

21
Q

What is Leukostasis

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A

Life-threatening complication
Caused by a high leukemic WBC count in peripheral blood
Blood thickens and blocks circulatory pathways

22
Q

Leukemia Diagnostic Studies To diagnose and classify types of leukemia

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A

Peripheral blood evaluation
Bone marrow examination

23
Q

Leukemia Diagnostic Studies To identify cell types and stage

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A

Morphologic, histochemical, immunologic, and cytogenic methods

24
Q

Leukemia Diagnostic Studies To determine the presence of leukemic cells outside of blood and bone marrow

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A

Lumbar puncture
CT scan

25
Leukemia Interprofessional Care what is the initial goal
***_to attain remission_*** Complete, partial, or molecular Prognosis is directly related to ability to maintain a remission Prognosis becomes more unfavorable with each relapse
26
Leukemia Interprofessional Care treatment
***_Chemotherapy_*** Induction: Aggressive TX- Watch for infection and bleeding complications Postinduction or postremission (consolidation)- Another tx to get whatever remains Maintenance
27
Leukemia Interprofessional Care other treatments
Induction Therapy Consolidation therapy Maintenance Therapy Corticosteroids Radiation therapy Immunotherapy and targeted therapy
28
What is Induction Therapy
Attempt to induce remission Seek to destroy leukemic cells in tissues, peripheral blood, and bone marrow ***_Patient may become critically ill Provide psychologic support as well_*** Postinduction or Postremission chemotherapy
29
What is Consolidation therapy
Started after remission is achieved ***_Eliminate remaining leukemic cells that may not be pathologically evident_***
30
Maintenance Therapy
Lower doses of the same drugs given ***_every 3 to 4 weeks_*** Goal is to keep body free of leukemic cells
31
What is radiation therapy?
Total body radiation in ***_preparation for bone marrow transplantation_*** Organ- or field-specific such as liver or spleen
32
Leukemia Hematopoietic Stem Cell Transplant
Goal Totally eliminate leukemic cells using combinations of chemotherapy with or without total body irradiation ***_Eradicates patient’s hematopoietic stem cells_***
33
Leukemia Stem Cell Transplantation
Replaced with those of an ***_HLA-matched-HUMAN LEUKOCYTE ANTIGEN MATCHED_*** Sibling- Volunteer Identical twin Or replace with own stem cells
34
Nursing Management Assessment Subjective data
Past health history Exposure to toxins, chromosome abnormalities, frequent infections Medications Previous chemotherapy Surgery or radiation treatments
35
Nursing Management Assessment objective data
Fever, lymphadenopathy, lethargy Pallor, jaundice, petechiae, ecchymoses CV - tachycardia, systolic murmurs GI - oral lesions-PRONE TO INFECTIONS or bleeding, herpes or infection, hepatomegaly, splenomegaly Seizures, disorientation, confusion Muscle wasting, bone or joint pain
36
Nursing Management Assessment diagnostic findings
WBC may be normal or abnormal Anemia ↓ Hct and Hgb Thrombocytopenia Philadelphia chromosome Hypercellular bone marrow aspirate or biopsy
37
Nursing Management Planning Overall Goals
***_Understand and adhere to treatment plan_*** Experience minimal side effects and complications of disease and treatment Establish realistic hope and goals, feeling supported during periods of treatment, relapse, and remission
38
Nursing Management Acute Care Many physical and psychologic needs
Evokes great fear Equated with death Family may need help Maximize physical function Provide hope Encourage discussion of concerns ***_Special challenges when meeting the intense psychosocial needs of a patient with leukemia_*** Patient empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life Involve services of interprofessional team
39
Nursing Management Acute Care
Review all drugs administered Be prepared to manage the sometimes life-threatening side effects of treatment-severe infections, bleeding D/O-could bleed out Assess lab data reflecting effects of drugs and sequelae of the disease
40
Nursing Management Ambulatory Care
Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse
41
Nursing Management Ambulatory Care Teach patient and caregiver
***_Diligence in disease management Need for follow-up care When to seek medical attention- any worsening symptoms or S/S of infection_***
42
Nursing Management Ambulatory Care Goals of rehabilitation
Manage the consequences Physical Psychosocial Social Spiritual
43
Nursing Management Evaluation Expected Outcomes
***_Cope effectively with the diagnosis, treatment regimen, and prognosis Experience no complications related to the disease or its treatment Feel comfortable and supported throughout treatment_***
44

Medical Surgical Exam 4 (11 decks)

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