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54 Cards in this Set
- Front
- Back
Platelet count
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150,000–450,000/mm3
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Prothrombin time (PT)
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11–12.5 sec
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Partial thromboplastin time (PTT)
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23–35 sec
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Leukemia caused by
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prolification of WBC's
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Leukemia
causes |
unknown
more common in industrialized countries gentic factors down syndrome exposure to radiation |
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Leukemia
clinical manifestations pediatric |
fever
pallor excesive bruising bone or joint pain lymphadenopathy abnormal WBC count mild to profound anemia and thrombocytopenia |
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Leukemia
diagnostic evaluation pediatric |
clincal manifestations
initial CBC bone marrow aspiration and biopsy |
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Leukemia
pathophys |
normal bone marrow is replaced by blast cells
cells infiltrate CNS and testicles |
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Leukemia
medical managment pediatric |
combination chemo
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Treatment of ALL
pediatric phases |
induction
consolidation maintanence |
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Child with leukemia
assessment |
Infection
oral/anal/perineal ulcers netropenic percautions bleeding nutrition skin care |
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Leukemia
A.Overview |
i. A significant cause for persistent leukocytosis is malignancy.
ii. Leukemia, literally “white blood,” is a neoplastic proliferation of one particular cell type (granulocytes, monocytes, lymphocytes, or infrequently erythrocytes or megakaryocytes) iii. Cause is not fully known. influences and viral pathogenesis may be involved. Bone marrow damage from radiation exposure or from chemicals such as benzene and alkylating agents (eg, melphalan [Alkeran]) can cause leukemia. |
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Acute Myeloid Leukemia
i. Overview |
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes (neutrophils,
basophils, eosinophils), erythrocytes, and platelets. |
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Acute Myeloid Leukemia
Overview; |
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes (neutrophils, basophils, eosinophils), erythrocytes, and platelets
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Acute Myeloid Leukemia
Clinical Manifestations |
a. Fever and infection from neutropenia
b. weakness and fatigue from anemia c. bleeding tendencies from thrombocytopenia. d. enlarged liver or spleen e. Hyperplasia of gums f. Bone pain |
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Acute Myeloid Leukemia Assessment and Diagnostic findings
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a. The CBC shows a decrease in both erythrocytes and platelets
b. bone marrow analysis shows an excess of immature blast cells (more than 30%). |
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Acute Myeloid Leukemia
Complictions |
a. Bleeding
b. Infection |
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Acute Myeloid Leukemia
Medical Management |
a. chemotherapy (induction therepy)
b. eradicate the leukemic cells c. consolidation therepy to eliminate any residual leukemia cells that are not clinically detectable and to reduce the chance for recurrence d. Bone marrow transplant e. supportive care |
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Acute Myeloid Leukemia Complication s of Treatment
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a. tumor lysis syndrome
b. increased uric acid and phosphorous levels increase risk for renal failure and renal calculi. c. Hyperkalemia and hypocalcemia d. Pts require increased fluid intake and allopurinal prophylaxis |
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Chronic Myeloid Leukemia
Overview |
a. Chronic myeloid leukemia (CML) arises from a mutation in the myeloid stem cell. Normal myeloid cells continue to be produced, but there is a pathologic increase in the production of forms of blast cells.
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Chronic Myeloid Leukemia
Clinical Manifestations |
a. The leukocyte count commonly exceeds 100,000/mm3
b. May have SOB or confusion c. enlarged liver/spleen d. malaise e. anorexia f. weight loss |
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Chronic Myeloid Leukemia
Medical Management |
i. imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. More useful in the chronic phase.
ii. In the chronic phase, the expected outcome is correction of the chromosomal abnormality iii. A less aggressive therapeutic approach focuses on reducing the leukocyte count to a more normal level but does not alter cytogenetic changes iv. In the acute form of CML (blast crisis), treatment may resemble induction therapy for acute leukemia, using the same medications as for AML or ALL v. Bone marrow transplant |
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Acute Lymphocytic Leukemia
Overview |
a. Acute lymphocytic leukemia (ALL) results from an uncontrolled proliferation of immature cells (lymphoblasts) derived from the lymphoid stem cell.
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Acute Lymphocytic Leukemia
Clinical Manifestations |
a. reduced numbers of leukocytes, erythrocytes, and platelets.
b. pain from an enlarged liver or spleen and bone pain c. headache and vomiting because of meningeal involvement. |
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Acute Lymphocytic Leukemia
Medical Management |
a. corticosteroids and to vinca alkaloids
b. prophylaxis with cranial irradiation or intrathecal chemotherapy c. Bone marrow transplant |
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Chronic Lymphocytic Leukemia
Overview |
a. More common in older adults
b. CLL is typically derived from a malignant clone of B lymphocytes c. most of the leukemia cells in CLL are fully mature |
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Chronic Lymphocytic Leukemia
Clinical Manifestations |
a. Increased lymphocyte Count
b. erythrocyte and platelets may be normal or decreased c. lymphadenopathy d. splenomegaly e. “B symptoms” f. Opppurtunistic infections |
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“B symptoms”
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1. fevers
2. drenching sweats (especially at night) 3. unintentional weight loss |
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Chronic Lymphocytic Leukemia
Medical Management |
corticosteroids and chemotherapy in later stages
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Lymphoma
Overview |
i. The lymphomas are neoplasms of cells of lymphoid origin. These tumors usually start in lymph nodes but can involve lymphoid tissue in the spleen, the GI tract (eg, the wall of the stomach), the liver, or the bone marrow
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Hodgkin's Disease
Pathophysiology |
a. Seen in the 20’s and again in 50’s
b. familial connection c. Woodworkers and those exposed to agent orange. d. initiates in a sinlge node e. The malignant cell of Hodgkin's disease is the Reed-Sternberg cell f. Viral conection(possibly Epstein barr virus) |
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Hodgkin's Disease
Clinical Manifestations |
a. Painless enlargement of one or more nosed on one side of the neck.
b. mediastinal mass may be seen on chest x-ray c. If the mass is large enough to compress the traches, dyspnea occurs. d. Puritis e. Brief, severe pain after drinking alcohol f. Can invade all organs, symptoms are dependent on which ones. g. “ B symptoms” h. Mild anemia |
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Hodgkin's Disease Assessment and Diagnostic Findings
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a. lymph node biopsy and the finding of the Reed-Sternberg cell
b. Asses for “B symptoms” c. Chest x ray, CT scan etc. d. CBC, ESR and liver and renal studies e. bone marrow biopsy |
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Hodgkins lymphoma
medical managment |
chemotherapy followed by radiation
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Long term Complications of Therepy
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a. Lung cancer
b. Breast Cancer c. Immune dysfunction d. Herpes infections (zoster and varicella) e. Pneumococcal sepsis f. Acute myeloid leukemia (AML) g. Myelodysplastic syndromes (MDS) h. Non-Hodgkin's lymphoma i. Solid tumors j. Thyroid cancer k. Thymic hyperplasia l. Hypothyroidism m. Pericarditis (acute or chronic) m. Cardiomyopathy o. Pneumonitis (acute or chronic) p. Avascular necrosis q.Growth retardation r.. Infertility s. Decreased libido t. Dental caries |
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Non-Hodgkin's Lymphomas (NHLs)
Overview |
The NHLs are a heterogeneous group of cancers that originate from the neoplastic growth of lymphoid tissue
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Non-Hodgkin's Lymphomas
insidence |
More common in people with immune deficiencies, prior treatment for cancer; prior organ transplant; viral infections (including Epstein-Barr virus and HIV); and exposure to pesticides, solvents, dyes, or defoliating agents, including agent orange
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Non-Hodgkin's Lymphomas
Clinical Manifestations |
a. Lymphadenopathy
b. “B symptoms” c. Lymphomatous masses d. Involvment in the CNS |
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Non-Hodgkin's Lymphomas
Assessment and diagnostic findings |
a. The actual diagnosis of NHL is categorized into a highly complex classification system based on histopathology, immunophenotyping, and cytogenetic analyses of the malignant cells.
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Non-Hodgkin's Lymphomas
Medical Management |
a. rituximab with conventional chemotherapy (Cytoxan, doxorubicin, vincristine, and prednisone [CHOP]) is now considered standard treatment for common, aggressive lymphomas
b. cranial radiation or intrathecal chemotherapy c. Bone marrow transplant |
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Thrombocytopenia
caused by |
1. decreased production of platelets within the bone marrow
2. increased destruction of platelets 3. increased consumption of platelets |
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Thrombocytopenia
Clinical Manifestations |
1. Petichea
2. Nasal and gum bleeding 3. Excessive menstral bleeding 4. Excessive bleeding after surgery and tooth extractions 5. When the platelet count is less than 5000/mm3, spontaneous, potentially fatal central nervous system or GI hemorrhage can occur |
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Thrombocytopenia
Assessment and diagnostic Findings |
1. Bone marrow aspiration and biopsy
2.Enlarged spleen 3. CBC |
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Thrombocytopenia
Medical Management |
1. Treatment of the underlying disease
2. Admistration of Platelets 3. Splenectomy |
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Thrombocytopenia
Nursing Interventions |
1. Prevent Complications
2. Control Bleeding 3. Evaluation and Expected Patient Outcomes |
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Febrile Nonhemolytic Reaction
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a. A febrile nonhemolytic reaction is caused by antibodies to donor leukocytes that remain in the unit of blood or blood component
b. chills followed by fever c. Muscle stiffness d. Non life threatening |
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Acute Hemolytic Reaction
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a. Life Thretaning
b. donor blood is incompatible with that of the recipient c. Fever d. lower back pain e. nausea f. Chest tightness h. dyspnea i. Anxiety j. hematuria k Hypotension, bronchospasm, and vascular collapse may result j. DIC |
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Allergic reaction
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a. urticaria (hives) or generalized itching
b. flushing c. if symptoms resolve with antihistamine the transfusion is resumed |
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Circulatory Overload
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a. diuretics may be administered after or between units
b. PRBC’s are better than whole blood c. dyspnea d. orthopnea e. tachycardia f. sudden anxiety g. Jugular vein distention, crackles at the base of the lungs, and an increase in blood pressure can also occur h. If sever; put patient in an upright position. Keep vein open. Call physician. Prepare to administer morphine and O2 for severe dyspnea. |
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Bacterial Contamination
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a. Packed red blood cells should be administered within 4 hours
b. Fever, chills and hypotension c. shock can occur if not treated promptly |
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Transfusion-Related Acute Lung Injury
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a. potentially fatal
b. Antibodies (usually in the donor's plasma) that are present in the blood component stimulate the recipient's leukocytes; aggregates of these leukocytes form and occlude the microvasculature within the lungs or damage the endothelium in the lungs c. fever, chills, acute respiratory distress (in the absence of other signs of left ventricular failure, such as elevated central venous pressure), and bilateral pulmonary infiltrates d. oxygen, intubation, diuretics may prevent death |
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Delayed Hemolytic Reaction
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a. occur within 14 days after transfusion
b. fever, anemia, increased bilirubin level, decreased or absent haptoglobin, and possibly jaundice. Rarely is there hemoglobinuria |
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Nursing Management for Transfusion Reactions
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a. Stop the transfusion. Maintain the IV line with normal saline solution through new IV tubing, administered at a slow rate.
b. Assess the patient carefully. Compare the vital signs with baseline. Assess the patient's respiratory status carefully. Note the presence of adventitious breath sounds, use of accessory muscles, extent of dyspnea, and changes in mental status, including anxiety and confusion. Note any chills, diaphoresis, jugular vein distention, and reports of back pain or urticaria. c. Notify the physician of the assessment findings, and implement any treatments prescribed. Continue to monitor the patient's vital signs and respiratory, cardiovascular, and renal status. d. Notify the blood bank that a suspected transfusion reaction has occurred. e. Send the blood container and tubing to the blood bank for repeat typing and culture. F. The identifying tags and numbers are verified. |
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If a hemolytic transfusion reaction or bacterial infection is suspected, the nurse does the following:
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1. Obtain appropriate blood specimens from the patient.
2. Collect a urine sample as soon as possible for a hemoglobin determination. 3. Document the reaction according to the institution's policy. |