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Neoplastic Hematological Disorders Flashcards

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1
Q

Uncontrolled growth of abnormal cells in the body

A

Cancer

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2
Q

type of cancer that affects the blood and bone marrow

A

Leukemia

“Leuk” -white
“Emia” -condition of the blood

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3
Q

2 types of Leukemia Cancer

A
  1. Acute
  2. Chronic
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4
Q
  • RAPID replication of immature WBCs that have developed a malignancy
  • May develop symptoms within weeks
  • Without warning
A

Acute Leukemia

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5
Q
  • involves more mature WBCs
  • disease onset is more gradual, may go years without symptoms
A

Chronic Leukemia

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6
Q

1st type of Leukemia:

Myeloid leukemia (an abnormal growth of the myeloid stem cell- turns into any cell except lymphocyte) is primarily classified into 2 main types

A
  1. Acute Myeloid Leukemia (AML)
  2. Chronic Myeloid Leukemia (CML)
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7
Q

Acute Myeloid Leukemia (AML):

The S/S result from insufficient production of

A

normal BLOOD cells in bone marrow
(includes RBCs, WBCs, Platelets)

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8
Q

S/S of Acute Myeloid Leukemia (AML)

A
  • Fever and infection
  • Weakness, fatigue, dyspnea on exertion, pallor
  • Petechiae, ecchymoses (bruising), bleeding tendencies
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9
Q

What age category is affected by AML?

A

adults

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10
Q

3 Diagnostics for Acute Myeloid Leukemia (AML)

A
  1. Physicall assessment
  2. CBC
  3. Bone Marrow Biopsy **
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11
Q

What cells are found in the Bone Marrow Biopsy that are the HALLMARK to AML?

A

BLAST cells
(immature leukocytes)

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12
Q

Acute Myeloid Leukemia (AML) Physical Findings

List 4

A
  1. Abdominal Pain
  2. Bone Pain
  3. Gingival infiltration- leukemic cells in gum
  4. Leukemia cutis- leukemic cells in skin
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13
Q

How to treat Acute Myeloid Leukemia (AML)

A
  1. Chemotherapy 2 stages only
    a. Induction chemotherapy: initial phase- very agressive
    b. Consolidation chemotherapy: aims at killing remaining leukemic cells- lower doses
  2. HSCT
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14
Q
  • Medical procedure where damaged or unhealthy blood cells in a patient’s body are replaced with healthy stem cells.
  • These stem cells can come from the patient themselves or from a donor.
A

Hematopoietic stem cell transplantation (HSCT)

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15
Q

Hematopoietic

A
  • process of blood cell formation.
  • production and development of various types of blood cells (RBC, WBC, and platelets) primarily in the bone marrow.
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16
Q

What are the 3 sources for stem cells.

A
  1. bone marrow
  2. peripheral blood
  3. umbilical cord blood
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17
Q

What are the 2 main complications for HSCT

A
  1. Infection
  2. Graft-Versus-Host Disease (GVHD) **

know

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18
Q

Graft-Versus-Host Disease (GVHD) attacks 3 main organs.

A
  1. Skin
  2. GI tract
  3. Liver
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19
Q

After Acute Myeloid Leukemia (AML) treatment what are 2 major complications?

A
  1. Disseminated intravascular coagulation (DIC)
  2. Tumor lysis syndrome
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20
Q

What happens in Disseminated intravascular coagulation (DIC)

A
  • Widespread activation of the clotting process in the blood vessels
  • Excessive clotting – massive amounts of tiny clots
  • Causes organ failure from ischemia (decr blood flow)
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21
Q

Disseminated intravascular coagulation (DIC):

Once body is no longer able to clott, the patient is at risk for

A

excessive bleeding

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22
Q

What occurs in TUMOR LYSIS SYNDROME

A
  • Massive leukemic cell destruction from chemotherapy
  • Lysed cells release toxins and fluids into blood circulation
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23
Q

What 3 substances increase in Tumor Lysis Syndrome?

A
  1. uric acid
  2. potassium
  3. phosphate

when K+ increases- calcium decreases

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24
Q
  • Type of cancer that affects the blood and bone marrow.
  • It is characterized by the overproduction/mutation of myeloid cells- (type of WBC involved in the immune response)
A

Chronic Myeloid Leukemia (CML)

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25
What is the **HALLMARK** genetic abnormality of Chronic Myeloid Leukemia (CML)?
Philadelphia (Ph+) chromosome
26
3 Clinical Manifestations for **Chronic** Myeloid Leukemia (CML)
* Might have **no** symptoms * e**levated WBC count detected** on routine CBC * May develop into **acute** phase
27
Patient with extremely **HIGH leukocyte counts** will show
* Shortness of breath * Enlarged, tender spleen * Occasional enlarged liver * Anorexia, weight loss
28
2 Main **Medical Managements** for **CML**
* **Tyrosinase Kinase Inhibitors (TKIs)** -medications ** * Hematopoietic Stem Cell Transplant (HCST) (*Treatments go in this order also- start with TKIs first*)
29
What do * **Tyrosinase Kinase Inhibitors (TKIs)** do?
* Decreased the need for stem cell transplant * Targets the BRC-ABL protein that causes the cancer cells to grow * **Attacks cancer cells without harming normal cells** **
30
In **Chronic Myeloid Leukemia**- Hematopoietic Stem Cell Transplant (HCST) treatment will only be used in patients less than ___ years of age.
65 years of age
31
How does effective TKI therapy impact **life expectancy** in Chronic Myeloid Leukemia (CML) patients?
Effective TKI therapy can lead to a **normal life expectancy** in CML patients.
32
*Another type of Leukemia*: * Leukemia that involves **lymphocytes**, a type of WBC important for the immune system.
Lymphocytic Leukemia
33
2 types of Lymphocytic Leukemia
1. **Acute** Lymphocytic/Lymphoblastic Leukemia (ALL) 2. **Chronic** Lymphocytic Leukemia (CLL)
34
An **aggressive** form of leukemia that leads to an **OVERPRODUCTION of lymphoblasts**, which are **immature lymphocytes**. This **interferes with the normal production of blood cells**
**Acute** **Lymphocytic/Lymphoblastic** Leukemia (ALL)
35
Acute Lymphocytic/Lymphoblastic Leukemia (**ALL**) is most common form in what age group?
children
36
Which **condition increases the risk** of developing Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?
Down Syndrome
37
What is the **treatment response** for children with Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?
A: Children with ALL are **very responsive** to treatment.
38
4 Clinical Manifestations for **ALL**
1. WBC may be **low or elevated** 2. **Infiltration to other organs** very common: *abdomoinal pain, bone pain* 3. **CNS involvement** common: *headache, vomiting* 4. May spread to **testicles and breasts**
39
Medical Management for **ALL** that makes it different from **AML**
**ALL has 3 chemo phases** for medical management. **AML has only 2 chemo phases**.
40
List Medical Managements for **ALL** **4 total** (*including the phases*)
1. Chemotherapy -Induction Phase: *Short, intensive, kill ALL leukemia* -Consolidation Phase: -**Maintenance phase** – *Less intensive; lasts for about 2 years* 2. **intrathecal chemotherapy**- *due to CNS involvement* - **unique to (ALL)** **
41
* Type of cancer that affects the **blood and bone marrow**, specifically targeting **mature B lymphocytes** * characterized by the **accumulation** of abnormal, mature B lymphocytes- **Cells dont die**
Chronic Lymphocytic Leukemia (CLL)
42
In Chronic Lymphocytic Leukemia (CLL), cells accumulate in 2 areas.
lymph nodes and spleen
43
5 Clinical Manifestations for CLL
* Many patient are asymptomatic – *CLL found during routine physical exam* * Increased lymphocyte count * **Enlargement of lymph nodes** (lymphadenopathy) * **Splenomegaly** * **Hepatomegaly**
44
3 Medical Management for CLL
1. Wait and watch in early stages 2. **combined chemo-immunotherapy** ** 3. Intravenous immunoglobulin (IVIG) – *if having recurrent infections*
45
Would Stem Cell Transplant be an option for OLDER patients with CLL?
No
46
Nursing Management for CLL
1. Monitor for complications- *same as acute* 2. Monitor lab results: *Creatinine, Electrolyte levels, etc* 3. Report culture results immediately 4. **Bleeding precautions**: *soft toothbrush, use electric razor, prevent constipation, avoid sharp objects, prevent falls* 5. **Neutropenic precautions**- *low levels of lymphocytes WBC. Important to prevent infection!!!*
47
A rare blood cancer characterized by the **overproduction of red blood cells**, which can lead to **increased blood viscosity**
Polycythemia Vera (*can also result in too many WBC or Platelets*)
48
S/S of Polycythemia Vera
* Reddish (Ruddy) skin complexion * **Increased blood viscosity**: *Angina, dyspnea, claudication, thrombophlebitis* * **Pruritus (itching)** * Bone pain * Fatigue * **Elevated uric acid levels**: *waste product*
49
**Increased** Uric Acid causes
gout, kidney stones, kidney damage
50
4 Diagnostic Findings for **Polycethemia Vera**
* Increased HGB & HCT * Increased WBC & Platelets * **Genetic testing**– mutation in JAK2 gene ** * **Bone marrow biopsy** *Memory: Vera & Jack*
51
List 3 Complications for **Polycythemia Vera**
* blood thickens * Increased platelets- *functionality of platelets can be impaired leading to **increased risk of bleeding*** * Increased risk for **venous or arterial thromboses** - heart attack, stroke **
52
List 3 Medical Managements for **Polycythemia Vera**
* **Low-dose aspirin** * **Phlebotomy**: *remove 500 mL blood once or twice weekly* - Goal maintain HCT < 45% * Meds
53
Important Patient teaching for Polycythemia Vera
Avoid Iron supplements and multivitamins
54
* Type of cancer that originates in the **lymphatic system**, which is a crucial part of the immune system. * Tumors start in the **lymph nodes**
Lymphoma
55
2 types of Lymphoma
1. Hodgkin Lymphoma 2. Non-Hodgkin Lymphoma
56
Which Lymphoma am I? * Characterized by the presence of **Reed-Sternberg cells** ** * Associated with **Epstein-Barr Virus** * starts in single lymph nodes and **spreads in an orderly fashion**
Hodgkin’s Lymphoma
57
Hallmark of Hodgkins Lymphoma
Reed-Sternberg cells
58
List 2 Clinical Manifestations of **Hodgkin Lymphoma**
1. First: painless, enlarged lymph nodes 2. **Cluster** of symptoms known as “**B symptoms**”
59
What are the B symptoms
Systemic symptoms that include: * Fever without chills * Drenching sweats, especially at night * Unintentional weight loss
60
4 Most important Diagnostics For Hodgkins Lymphoma
* **Lymph node biopsy** * Chest XRAY * **CT Scan**: *Identify extent of lymphadenopathy* * **Positron emission tomography (PET) scan**: *after therapy to determine effectiveness*
61
List 2 Main Medical Managements for **Hodgkin Lymphoma**
* **Limited stage** - Short course of chemotherapy (*2 to 4 months*) * **Radiation**- *first cancer can do this bc its solid tumor*.
62
Nursing Management for **Hodgkin Lymphoma**
* Monitor for **systemic side effects** of **chemotherapy and radiation** * High risk of infection * complications based on location of radiation
63
*2nd type of Lymphoma* * Can originate **outside** of the lymph nodes (e.g. spleen, thymus) * **Spread can be unpredictable** * Most patient have wide spread disease at time of diagnosis
Non-Hodgkin Lymphoma
64
Medical Management **Non-Hodgkin Lymphoma**
1. Similar to Hodgkin Lymphoma ** 2. **Radiation**- if not aggressive 2. Combination chemo/monoclonal antbx (**MoAb**) 3. **HSCT** may be considered for patients **younger than 60** 4. Treatment for low WBC
65
*Non-Hodgkin Lymphoma*: What 2 meds are used for Treatment of low WBC?
* **Filgrastim** (Neupogen) * **Pegfilgrastim** (Neulasta) *WBC growth factor* **know**
66
* Type of blood cancer that originates in the **PLASMA cells**
Multiple Myeloma
67
* Where do Plasma cells originate
Bone Marrow
68
*Multiple Myeloma*: What do these abnormal plasma cells do to the **bone**?
infiltrate the bone marrow and crowd out the healthy blood cells and **cause bone destruction**
69
*Multiple Myeloma*: What do the abnormal plasma cells do to **organs**?
Rather than produce helpful antibodies, the cancer cells **produce abnormal proteins (M-proteins)** that **cause organ damage**
70
**5** S/S of **Multiple Myeloma**
1. Bone pain: *pelvis, spine & ribs* 2. Bone degeneration 3. Diffuse (allover) osteoporosis: *Myeloma protein destroys bone* 4. Vertebral destruction 5. Bone fractures
71
4 Diagnostic tests for Multiple Myeloma
* Blood tests * Urine tests * Bone marrow examination * Imaging tests – to detect bone problems
72
*Multiple Myeloma*: Blood tests and Urine tests are done to find what exactly?
**M Proteins** - produced by myeloma cells
73
Medical Management for **Multiple Myeloma**
**No cure** – treatment designed to extend remission or relieve symptoms
74
What **EARLY** treatment options are available for **Multiple Myeloma**
1. **Corticosteroids** (Dexamethasone)- often combined with: *Immunomodulatory drug & Proteasonme inhibitor* 2. ***Autologous*** **Stem Cell Transplant (HSCT)**- own stem cells
75
**Multiple Myeloma** Nursing Management
1. Pain management – *NSAIDS* 2. **Activity restriction** – *lifting no more than 10 pounds* ** 3. **Biphosphonate therapy** ** -*Improves bone pain* -*Importance of comprehensive oral hygiene to prevent osteonecrosis of the jaw* 4. **Renal function**: *Maintain urine output of 3L/day*

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