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31 Cards in this Set

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LEUKEMIA
WHITE BLOOD
-UNREGULATED PROLIFERATION OF WBC'S IN BM AND OTHER TISSUES
CAUSE OF LEUKEMIA
MAYBE DEFECT IN STEM CELL
LEUKEMIA ACCOUNTS FOR 5 PERCENT OF ALL CANCERS
MORE ADULTS HAVE LEUKEMIA>CHILDREN
CELL LINE
MYELOID-MYELOCYTIC
MYELOGENOUS
LYMPHOID-LYMPHOCYTIC
MATURITY OF CELL
ACUTE=IMMATURE CELLS (RAPID GROWING "BLASTS")
CHRONIC=MORE DIFFERENTIATED (SLOWER GROWING)
ETIOLOGY
UNKNOWN
VIRAL?GENETIC?ENVIRONMENTAL?
ASSSESSMENT
HISTORY:
1.ACUTE-S/S COMMON INFECTIOUS ILLNESS
2.CHRONIC-MORE SUBTLE
S/S:FATIGUE,NIGHT SWEATS
3.LATER-SYMPTOMS DUE TO CROWDING OUT OF NORMAL B.M.
WHAT HAPPENS IF SYMPTOMS CROWD OUT DUE TO NORMAL B.M.?
THE RBC'S DECREASE,THE PLATELETS DECREASE,AND THE WBC'S DECREASE
-ANEMIA=FATIGUE
-PLATELETS=THROMBOCYTOPENIA
-ABNORMAL WBC=PRONE TO INFECTION
WHAT OTHER S/S SEEN
PAIN=INCRESES INFILTRATION,ELARGEMENT OF ORGANS,LEADS TO:INCREASED INTRACRANIAL PRESSURE
-ANOREXIA
-CNS INFILTRATION
-ANXIETY
-HYPERURICEMIA=INCREASED URIC ACID
CLINICAL DATA:
INCLUDES PLATELET AND CBC COUNT
-LOW Hgb
-NORMAL
-HIGH OR LOW WBC
-LOW PLATELETS
2.BONE MARROW ASPIRATION
3.LYMPHNODE BIOPSY
4.LUMBAR PUNCTURE
5.CAT SCAN
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
ACUTE=IMMATURE CELLS
AKA=CHILDHOOD LEUKEMIA
PEAK AGE=4
**BEST PROGNOSIS**
THIS CANCER INFILTRATES TO OTHER ORGANS(ESP.BRAIN AND SPINAL CORD)
-CHILDREN (80% SURVIVE >5YRS)
-ADULTS (60%)
TXT FOR ACUTE LYMPHOCYTIC LEUKEMIA
1.CHEMO
2.RADIATION AND CHEMO TO CNS
3.HOW DO YOU GET CHEMO TO BRAIN AND SPINAL CORD? **INTRATHECAL PROCEDURE***
A.INDUCTION
B.CONSOLIDATION
C.MAINTENANCE
INDUCTION
ERADICATE THE LEUKEMIC CELLS
-IV CHEMO:LASTS 4 WKS
GIVEN-***PREDNISONE,ASPARAGINASE,VINCRISTINE
-NEUTROPENIA
-THROMBOCYTOPENIA
-ANEMIA
CONSOLIDATION
POST REMISSION
TO ELIMINATE ANY RESIDUAL CELLS
-LASTS 6 MONTHS:INTENSE
-MAY NEED HOSPITALIZATION
-INTRATHECAL MEDS:RT TO CNS
MAINTENANCE
2-3 YRS MEDICAL TXT
-MOST PO,SOME IV
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
MILD DISORDER
-AGE >40 2/3>60 YRS OLD
-ASYMPTOMATIC
-LYMPHOCYTOSIS (HIGH WBC)ALWAYS PRESENT
-PROGRESSION UP TO 15 YRS
TXT FOR CLL
MILD=NONE
SEVERE=**CYTOXAN,LEUKERAN
ORGAN DRUG:(SPECIFIC FOR LYMPHOCYTIC LEUKEMIA)CALLED"A
ACUTE MYELOGENOUS LEUKEMIA (AML)
(ANLL=ACUTE NON LYMPHOCYTIC LEUKEMIA)
-ALL AGE GROUPS (INCREASE W/AGE)
-INSIDUOUS ONSET=1-6 MONTHS
-PRESENCE OF AUER RODS IN CYTOPLASM
TREATMENT FOR AML
1.CHEMO->REMISSION 1 YR OR GREATER
2.BONE MARROW TRANSPLANT ON 1ST REMISSION
AML IS RESISTANT TO TXT !
70% RELAPSE AFTER CHEMO-**BEST IF GIVEN BONE MARROW TRANSPLANT
PROGNOSIS:PT USUALLY DIES W/IN 2-5 MOS
CHRONIC MYELOGENOUS LEUKEMIA (CML)
MORE NORMAL CELLS PRESENT THAN W/ ACUTE DISEASE=MILDER
-AGE=40
-LEUKOCYTOSIS IS ALWAYS PRESENT
(WBC'S CAN INCREASE TO 500,000)
-PHILADELPHIA CHROMOSOME FOUND IN 90-95% OF PTS
TXT FOR CML
1.**GLEEVAC-P.O.(IMATINILOMESYLATE)
2.ONLY CURE IS BONE MARROW TRANSPLANT
PROGNOSIS FOR CML
LIFE EXPECTANCY IS 3-5 YRS
WHAT ARE THE 3 PHRASES OF CML?
1.CHRONIC
2.ACCELERATED
3.BLAST CRISIS
WHAT IS GIVEN DURING ACCELERATED PHASE OF CML?
1.INTERFERON
2.ALLOGENIC BMT
NSG DIAGNOSIS
SAME AS FOR APLASTIC ANEMIA
-RISK FOR INJURY/BLEEDING
-ANXIETY
-GRIEVING
-POWERLESSNESS
GOAL FOR CML
INCREASE STRENGTH AND ENDURANCE
WANT ABSENCE OF INFECTION,BLEEDING,PAIN
HELP COPE W/DIAGNOSIS,TXT,PROGNOSIS
REMISSION
A HEALTHY STATE IN WHICH ALL
ABNORMAL,IMMATURE, USELESS CELLS DISAPPEAR FROM B.M. AND BLOOD STREAM
NSG CARE FOR LEUKEMIA IS RELATED TO __
BONE MARROW SUPPRESSION
**PREVENT AND CONTROL INFECTION**-MAJOR CAUSE OF DEATH
NSG MEASURES FOR LEUKEMIA
-CULTURE,ANTIBIOTIC
-CHECK LOC,CHECK RESPIRATORY
-SOMATITIS(NORMAL SALINE)
-ASEPTIC TECH
-NO RECAL TEMP-ABSESSES COMMON
-NO TYLENOL-WILL MASK THE TEMP
-REVERSE ISOLATION CONTROVERSIAL
-NO ASPIRIN
NSG TXT FOR CHEMO
-GOOD NUTRITION (ANTIEMETICS,DO NOT GIVE FAVORITE FOOD)
-RENAL STONES (ALLOPURINOL)
-HYDRATION (ELECTROLYTE SUPPLEMENTS)
-TUMORLYSIS SYNDROME
WHAT NEW DRUG GIVEN TO LOWER URIC ACID LEVELS?
RASBURICASE (ELITEK) IV-PEDIATRIC POPULATION
PT IS MORE PRONE TO __ IF PT GETS LEUKEMIA
HODGKINS