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18 Cards in this Set
- Front
- Back
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Hyperleukocytosis |
1. Peripheral WBC count is > 100k, causing increased blood viscosity and blast-cell aggregates, and thrombi in the microcirculation.. 2. 9-13% A.L.L., 5-22% AML, all CML.. 3. More common in infant A.L.L and AML, the blast phase of CML, T-cell A.L.L with a mediastinal mass, and hypodiploid A.L.L.. |
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S & S of hyperleukocytosis |
- SOB, tachypnea, cyanosis.. - blurred vision, headaches, seizures.. - papilledema.. - agitation, ataxia, confusion, delirium, and stupor.. |
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Management of hyperleukocytosis |
1. I.V. hyperhydration.. 2. bicarb.. 3. allopurinol or rasburicase.. 4. blood transfusion, leukopheresis, exchange transfusions, and chemo. |
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TLS |
1. Hyperuricemia: uric acid > 8.. 2. hyperphosphatemia: phos >10.. 3. Hyperkalemia: K > 6.. 4. Hypocalcemia: calcium <8.. 5. Elevated BUN and creatinine. |
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Risk factors for TLS |
- Patients with T-cell A.L.L, Burkitt and other B-cell NHL, a significantly elevated WBC count, an elevated uric-acid level, and LDH > twice the normal upper limits.. - Patients with a large tumor burden with lymphadenopathy, mediastinal mass, hepatosplenomegaly, and renal insufficiency. |
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S & S of TLS |
1. Rapid onset, may begin at prediagnosis, at 6-48hours after initial treatment, and up to 7 days after.. 2. Abnormal lab results; flank pain, hematuria; decreased UOP; lethargy; N/V; edema; muscle cramps and twitching; numbness and tingling; carpopedal spasms; SEIZURES; diarrhea; respiratory distress; belly fullness or ascites; irregular heartbeat. |
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Nursing management of TLS |
The single most important intervention is hydration.. 1. I.V. hydration with D5NS, no K.. 2. Maintain UOP > 3-5 cc/kg/hour, urine SG < 1.010, pH at 7.0-7.5.. 3. Monitor for edema (weight).. 4. Seizure precautions. |
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Risk factors for septic shock |
- Prolonged neutropenia (> 7days).. - ANC < 100.. - Breaks in skin and mucus-membrane.. - Invasive devices.. - malnutrition.. - asplenia.. - If patient is 7-10 days post chemo with fever/ lethargy, work-up for sepsis.. |
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Medical management of septic shock |
- Volume resuscitation is the most important intervention.. - Antimicrobials is the only proven treatment.. - May lead to D.I.C.. |
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Disseminated Intravascular Coagulation (DIC) |
1. Intravascular consumption of platelets and plasma clotting factors. 2. Decreased platelets (< 20); increased PT, PTT; decreased fibrinogen; increased D-dimer. 3. Diffuse uncontrolled bleeding may be present. 4. Gram-negative sepsis is the most common cause of DIC in children with cancer. |
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Typhlitis |
1. A bacterial invasion of the cecum that leads to necrotizing colitis as a result of chemo damage to the intestinal mucosa in the context of neutropenia.. 2. Range from inflammation to full-thickness infarction, perforation, or both. |
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S & S of typhlitis |
- Neutropenia.. - abdominal pain in the RLQ.. - distended abdomen.. - high-pitched, diminished, or absent bowel sounds.. - N/V and diarrhea. |
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Syndrome of inappropriate antidiuretic-hormone secretion (SIADH) |
1. A high circulating level of ADH in the absence of a physiologic stimuli.. 2. A decrease in UOP, and an increase in weight without edema, leading to hyponatremia and water intoxication.. 3. The most common cancers are: CNS tumors, Hodgkin lymphoma, and NHL. |
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Chemo agents associated with SIADH |
Cisplatin, Cytoxan, and VCR. |
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S & S of SIADH |
1. Early (Na < 130): thirst, anorexia, headache, muscle cramps, weakness, and lethargy.. 2. Midcourse (Na < 125): N/V, hyporeflexia, confusion.. 3. Late (Na < 120): seizures, coma, death. |
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Pancreatitis |
Can be life-threatening in immunocompromised host.. Causes are: - Pancreatic enzyme release.. - Pulmonary or capillary alteration.. - Systemic perfusion compromise.. |
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S & S of pancreatitis |
- Radiating abdominal pain.. - N/V.. - Dizziness.. - Abdominal distension.. - Diminished bowel sounds.. |
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Renal Toxicities |
1. Renal insufficiency: - Baseline creatinine doubles.. - GFR decrease by 50%.. 2. Renal failure: - Baseline creatinine triples.. - Creatinine > 4.0 mg/dl.. - GFR decrease by 75%.. |
