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320 Cards in this Set
- Front
- Back
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______ Americans dx with Ca each year
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1.3 million
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Cancer is the _____ leading cause of death.
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2nd
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More than ________ people die from a malignant process
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500,000
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Male % of cancer in each
Lung Prostate Colorectal |
31%
11% 10% |
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Female % of cancer in each
Lung Breast Colorectal |
25%
15% 11% |
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_______begins when an abnormal cell is transformed by genetic mutation of the cellular DNA
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Cancer
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The abnormal cell forms a _____ and begins to proliferate abnormally, ignoring growth regulating signals in the environment surrounding the cell
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Clone
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The cell acquires________characteristics and changes occur in the surrounding tissues
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invasive
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The cells_______these tissues and gain access to _____ and ______ which carry the cells to other areas of the body
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infiltrate
lymph, blood vessels |
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Increased number of cells
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Hyperplasia
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Conversion of one type of mature cell to another type of cell
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Metaplasia
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Bizzare cell growth resulting in cells that differ in size, shape or arrangement from other cells of the same type of tissue
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Dysplasia
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Cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin (usually malignant)
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Anaplasia
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Uncontrolled cell growth that follows no physiologic demand
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Neoplasia
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Refers to growth of the primary tumor into the surrounding host tissue by mechanical pressure and by destructive enzymes. (fingerlike projections into cells)
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Invasion
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Refers to the dissemination of malignant cells from the primary tumor to distant sites by direct spread of tumor cells to body cavities or thru lymph or circulatory system
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Metastasis
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Most common mechanism of metastasis, enter channels by way of the interstitial fluid, may enter thru invasion, areas of rapid circulation are at greatist risk
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Lymphatic spread
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Directly related to vascularity of the tumor, few can survive turbulance, attach to endothelium, destroy surrounding tissues
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Hematogenous spread
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Stimulate formation of new blood vessels which helps the malignant cell obtain necessary nutrients and oxygen
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Angiogenesis
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3 Step cellular process
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Initiation
Promotion Progressing |
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These mutations are usually not significant until the next step
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Initiation
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Repeated exposure causes the expression of abnormal or mutant genetic information.. Vary by agent type, dose and innate characteristics of the target cells
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Promotion
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This step now exhibits increased malignant behavior, these cells show a propensity to invade adjacent tissues and to metastasize
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Progression
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Causative factors (6)
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Viruses/Bacteria
Physical agents Chemical agents Genetic/family factors Dietary factors Hormonal agents |
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Break down the DNA chain and incorporate themselves into the genetic structures of the cell
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Viruses and bacteria
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75% of all factors maybe related to environment.
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Chemical agents
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Retinoblastoma
Nephroblastomas Pheochromocytomas Malignant neurofibromatosis Breast, ovarian, endometrial, colorectal, stomach, prostate, & lung cancers |
Genetic and familial factors
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Diet that increases the risk of cancers (4)
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Fats
ETOH Salt cured or smoked meats Food containing nitrates and high calorie intake |
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Foods that decrease the risk of cancers
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High fiber foods (fruits/veggies/whole grains)
Cruciferous veggies(broccoli, cauliflower, brussel sprouts, kohlrabi) |
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When this fails to identify and stop growth of malignant cells clinical cancer develops
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Immune system
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This can detect the development of malignant cells and destroy them before cell growth becomes uncontrolled
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Immune systen
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May be promoted by the disturbance in hormonal balance either by the bodys own hormone production or by admin of exogenous hormones
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Hormonal Agents
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Recognizes cancer cells and stimulates both humoral immunity
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Immune Response
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_______are responsible for recognizing tumor associated antigens
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T Lymohocytes
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Antibodies produced by ________ also defend the body against malignant cells
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B Lymphocytes
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These are a sub population of lymphocytes that act directly destroying cancer cells or by producing lymphokines and enzymes that assist in cell destruction
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Natural Killer Cells
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Due to decrease in the production of RBC's
A reason for anemia |
Hypoproliferative
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Due to excessive destruction of RBC's.
A reason for anemia |
Hemolytic
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Due to a loss of RBC's
A reason for anemia |
Bleeding
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This type of anemia can be due to chronic blood loss (ulcers, gastritis, post menopausal bleeding) are common causes
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Iron Deficiency
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Diagnosis of Iron deficiency anemia is made with?
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Bone Marrow Aspiration
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Smooth, shiny, red, sore tongue
Corners of mouth red and cracked Pica |
Iron deficiency anemia
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Oral iron (ferrous sulfate) or IM/IV iron dextran for this type of anemia
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Iron deficiency anemia
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RBC's that are small and devoid of pigment are called
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Hypochromia
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Nutrition for Iron deficiency anemia
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Meat
Liver Green leafy veggies Vit C (enhances absorption) |
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This type of anemia can be due to a nutritional deficiency
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Iron deficiency anemia
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This is the most common type of anemia
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Iron deficiency anemia
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This type of anemia is due to a destruction of bone marrow. hypoproliferative
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Aplastic anemia
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This anemia is congenital, acquired or idiopathic
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Aplastic anemia
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Bone marrow is replaced with fat in this type of anemia
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Aplastic anemia
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Depression of all blood forming elements which results in pancytopenia, leukopenia, thrombocytopenia.
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Aplastic anemia
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Diagnostic test for Aplastic anemia
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Bone marrow biopsy
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The defect originates in the stem cell in this type of anemia
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Aplastic anemia
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Classic sx of anemia
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Pallor
Fatigue Palpitations SOB Purpura Bleeding |
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Tx for Aplastic anemia
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BMT from a donor that has identical human leukocyte antigen (HLA) is choice for people younger than 60
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Another tx for aplastic anemia
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Immunosuppressive therapy: antithymocyte globulin (ATG), transfusions for RBC's and platelets PRN
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This type of anemia is due to vit b12 deficiency
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Pernicious anemia
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This anemia is from faulty absorption of the intrinsic factor produced by the cells of the gastric mucosa
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Pernicious anemia
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Nutritional deficiencies, autoimmune reaction, gastrectomy, celiac disease, ileal resection and IBD are some causes of this anemia
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Pernicious anemia
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Dx testing for pernicious anemia
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CBC, bone marrow exam, iron level, SCHILLING TEST
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This test is to determine between a dietary B12 deficiency and B12 malabsorption.
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Schilling test
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NPO for 12 hrs
Given radioactive dose of B12 and IM dose 24 hr urine |
Schilling test
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High doses of radioactivity in the urine is a + sx for?
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Pernicious anemia
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Sx of pernicious anemia
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CNS: confusion, paresthesia, dementia, PROPRIOCEPTION
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Tx for pernicious anemia
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B12 replacement therapy for life
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This is a megaloblastic anemia similar to a B12 deficiency
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Folic acid deficiency
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This is necessary for the normal production of RBC's
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Folic Acid
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This type of anemia is most commonly R/T dietary deficiency esp w/ eldery and alcoholics
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Folic Acid deficiency
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A diet lacking in uncooked fruits and veggies or overcooking veggies can result in
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Folic acid deficiency
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Some medications can inhibit the enzyme involved in normal folate absorption thru the intestinal wall resulting in
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Folic acid deficiency
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Lab findings include macrocytic anemia, bone marrow changes in
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Folic acid deficiency
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Dx tests for folic acid deficiency
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CBC, bone marrow aspiration, Serum folic acid.
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Clinical manifestations for folic acid deficiency are the same as pernicious anemia except for the
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Neuro changes
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There is an increased need for this during pregnancy to prevent neural tube defects
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Folic Acid
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Tx for folic acid deficiency
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1mg folic acid po daily
IM in case of malabsorption |
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This type of anemia is due to a premature destruction of RBC's so fast that the bone marrow is unable to compensate
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Hemplytic anemia
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Normal life span of a RBC
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120 days
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In this type of anemia the erythrocytes have a shortened life span
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Hemolytic anemia
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These can also develop as a result of abnormal hemoglobin synthesis as in sickle cell disease
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Hemolytic anemia
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Causes of hemolytic anemia
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Trauma
TB Lead poisoning Infections Transfusion rx Toxic agents |
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In this type of hemolysis the spleen removes erythrocytes from circulation at a much faster rate
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Extravascular hemolysis
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In this type of hemolysis there is erythrocyte lysing and spilling the cell contents into the plasma
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Intravascular hemolysis
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Dx for hemolytic anemia
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H and H (decreased)
Reticulocyte count (elevated) compensatory |
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Tx for hemolytic anemia
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Tx the disease
RX: corticosteriods, foic acid, blood transfusions, spleenectomy |
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Most common genetic disorder in the US, occuring mostly in african americans
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Sickle cell disease
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The defect is a single amino acid substitution in the B chain of hemoglobin. Glutamine for valine
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Sickle cell disease
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This intermolecular arrangement HbS is formed instead of HbA
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Sickle cell disease
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RBC's become crescent shaped and there is a decreased oxygen carrying capacity content in the blood
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Sickle cell disease
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Sickeled cells ______ the viscosity of the blood. Slowing circulation and causing cellular hypoxia
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increase
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When one parent has sickle cell trait a ___% probability exists that the child will have it.
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50%
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When both parents have sickle cell trait there is a ___% chance that the child will have sickle cell disease and a ___% chance of sickle cell trait.
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25%
50% |
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Persons with sickle cell trait have inherited____abnormal gene
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one
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_____% of african americans have sickle cell trait
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8-12%
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This disease is often diagnosed in early childhood because the child is anemic
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Sickle cell disease
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1st sx of sickle cell disease in infants is
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Colic (abd pain)
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Pain is a predominant symptom R/T decreased tissue perfusion
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Sickle cell disease
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Tx for joint pain in sickle cell disease
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Elevate
Ice Decrease ROM |
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Bacterial infection is a major cause of morbidity and mortality in these pts
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Sickle cell disease
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Osteoporosis may occur due to the rapid growth of bone marrow in this
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Sickle cell disease
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Sx in sickle cell disease
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Dehydration
Jaundice Palpate liver and spleen for enlargement Assess urine output |
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A painful penile erection called priapism is not uncommon in this
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Sickle cell disease
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Dx for sickle cell disease
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CBC, sickledex test, hemoglobin electrophoresis
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This detects cell hemoglobin
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Sickledex test
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This distinguishes sickle cell trait from sickle cell disease
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Hemoglobin electrophoresis
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Nursing mgmt in sickle cell disease
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Control pain (MS) and rehydrate
Iron, B12, to promote RBC production. Antibiotics to combat infection |
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This drug has been used in sickle cell disease, pain is lessened, has a carcinogenic effect
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Hydroxyurea
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This enhances the absorption of Iron
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Vitamin C
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Foods high in vitamin C
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Oranges
Broccoli Strawberries Tomatoes OJ |
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Oral preparations of iron are best absorbed when_______
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taken between meals. 1 hr before or 2 hrs after with an 8oz glass of juice or water
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Iron is not given concurrently with_____ because these slow absorption
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Antacids
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____and_____ can also inhibit absorption.
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Milk and eggs
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This is the oldest iron product, the least expensive, the most effective and is the standard
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Ferrous Sulfate
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This is given 50mg/mL used for iron deficiency anemia. Majority well absorbed within 72 hours and the remaining drug is absorbed over 3-4 weeks
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Iron Dextran Imferon
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Iron toxicity produces these sx
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N/V/D, and abdominal distress
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Administer iron _____hrs after cycline antibiotics
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2-3
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Iron given IM is given this way
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Z track
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IM iron is given only in this area
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Buttocks
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This is used to treat and correct pernicious anemia
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B12 Cyanocobalamin
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Followin administration of IM iron pt should remain on bedrest for_______
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30 minutes
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This is essential for body growth and DNA synthesis
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Folic Acid
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Given to women during pregnancy to prevent neural tube defects
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Folic Acid
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Prior to administering blood you want to verify?
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Physician order
Signed consent Blood is typed and cross matched Explain procedure to pt |
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Safety measures prior to administering blood
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Double check blood with another nurse to make sure type and compatibility match.
Check the pts info against blood. Check VS for baseline. |
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Make sure that the blood does not have any_____, ______, or _______.
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Gas bubbles, cloudiness, or color discoloration
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Gas bubbles in the blood could signal
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Bacterial growth
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Cloudiness in the blood could signal
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Hemolysis
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Wear______ in compliance w/ universal precautions in administering blood.
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gloves
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Record ______ prior to administering blood
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vital sx
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Make sure blood is administered within_____min of removing it from refrigeration
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30
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Equipment for blood administration
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Y tubing w/ filter
NS 20 gauge needle |
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For the first_____min run the blood transfusion slowly no more than______
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15 min
25m |
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One unit of blood usually infuses in______hrs and does not exceed_____hrs
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2hrs
4hrs |
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If you are on hour 3 and the blood still has not infused do what
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Call the doctor
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This occurs from rapid infusion. Onset occurs in 1 hour. Sx of pulmonary congestion, increased HR, bounding pulse, distended neck veins, labored breathing
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Circulatory overload
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When you suspect circulatory overload the first thing you should do is?
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Stop the transfusion
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This type of reaction is caused by contamination of blood products during the handling or collection of blood
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Sepsis
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This blood reaction shows sx of shock
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Sepsis
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This is the most common type of blood reaction, caused by sensitivity to the donor's wbc's, platelets or plasma
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Febrile (non-hemolytic)
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This occurs within the frist 15 minutes w/ sudden chills, and fever, headache, muscle pain, flushing and anxiety
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Febrile
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This type of reaction is the most serious and protentially life threatning. It is caused by incompatible blood
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Acute hemolytic reaction
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This type of reaction shows sx of shock, cardiovascular collapse, low back pain, MI, bleeding
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Acute hemolytic reaction
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This is a sensitivity to the donor plasma protein, causes flushing, urticaria
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Allergic reaction
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A term used to refers to an increase in both the number of circulating erythrocytes and the concentration of HGB in the blood
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Polycythemia
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A proliferative disorder in which the marrow cells reproduce out of control
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Polycythemia Vera
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Consequences of this disease are increase in blood viscosity, which leads to severe congestion in tissues and organs
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Polycythemia
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S/S of Polycythemia
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HTN
Headache Blurred Vision Vertigo Tinnitus Thrombosis Skin is red & ruddy Splenomeagly and hepatomeagly |
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Lab tests for polycythemia show
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Increased RBC's, Hct, liver enzymes, and uric acid
Bone marrow shows increase in immature cells |
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Tx for polycythemia
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Phlebotomy, alkylating agents, radioactive phosphorous or myleran. Gout meds
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Interventions for polycythemia
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Monitor for bleeding
Force fluids, monitor I/O Prevent DVT's, monitor for CHF, Avoid ASA, ETOH Take tepid cool baths and cocoa butter lotions |
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A decrease in the number of platelets is called
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Thrombocytopenia
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An increase in the number of platelets is called
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Thrombocytosis
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Normal platelet count is
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150,000-400,000
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These play a vital role in the body's ability to coagulate blood
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Platelets
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This is the most common cause of abnormal bleeding
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Thrombocytopenia
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A sudden onset of bleeding and petechia are characteristic sx of this disorder
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Thrombocytopenia
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When the platelet count falls below_____ gingival bleeding, nosebleeds, excessive menstural bleeding, hemorrhage after surgery and dental extraction occur.
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20,000
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If platelet count falls below_____ CNS hemorrhage or GI hemorrhage occur
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5,000
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Dx tests for thrombocytopenia
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Looking at platelets and bleeding time. Low platelets and prolonged bleeding time. PT and PTT are NORMAL
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TX for thrombocytopenia
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Tx the underlying cause, if med induced stop the med. RX: corticosteroids, Folate, platelet transfusions, spleenectomy
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Nursing interventions for thrombocytopenia
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Prevent injury:
Soft toothbrush Electric razor Minimize needle sticks Stop bleeding/ apply pressure Apply cold |
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Also called postviral thrombocytopenia which usually affects children between 2-6
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Acute thrombocytopenia
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Also called Werholf's disease affects adults under 50 yrs, esp women ages 20-40
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Chronic thrombocytopenia
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This results in an increased destruction of platelets w/ a platelet count less than 10,000 pt has petechiae and ecchymosis
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ITP
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In ITP platelets are destroyed by_______
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the immune system
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Acute ITP usually follows a _____ infection
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viral, such as chicken pox or rubella
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In acute ITP bleeding is sudden but can occur_____days after the virus strikes
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21
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Chronic ITP is often linked with disorders such as
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SLE, lupus erythematosus and HIV.
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Normal life span of platelets is_______days
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7-10
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In ITP the life span of platelets is_____
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1-3 days or less
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S/S of ITP
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Easy bruising
Nosebleeds Oral bleeding Purpura petechiae excessive mensturation cerebral hemorrhage |
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Tx for ITP
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short term: corticosteroids, IV gamma globulin, chemotherapy (vincristine), spleenectomy
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Platelet transfusions tend to be ineffective tx for this because they bind to the antiplatelet antibodies and are destroyed
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Platelet transfusions
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Nursing interventions for ITP
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Control bleeding
Obtain med hx Hx of viral illness NO IM injections NO ASA Pad crib/plapen Soft bristle toothbrush stool softeners No contact sports, suggest swimming, biking, golf and pool |
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This disorder is caused by deficiency in clotting factors, affects males more.
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Hemophilia
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Classic hemophilia effects 80% and is factor VIII deficient
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Hemophilia A
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Christmas disease 15% of hemophiliacs factor XI deficient
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Hemophilia B
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Female carriers of hemophilia have a ____% chance of transmitting the gene to each son
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50
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S/S of hemophilia
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Hemarthrosis (75%)
easy bruising limited ROM |
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Nursing interventions for hemarthrosis
|
Elevate
Ice Limit ROM |
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Dx for hemophilia
|
Family hx
Coagulation factor essays Activated PTT is prolonged (Increased) Platelet count and function, bleeding time and prothrombin time are normal |
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TX for hemophilia
|
Replace deficient factors
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Cryoprecipitate is tx for
|
Hemophilia A
|
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Recomninant factor VIII and IX is tx for
|
Hemophilia B
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Never administer ASA to
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Hemophiliacs
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Nursing mgmt for hemophiliacs
|
Control bleeding pressure for 15 min (constant)
Immobolize joints Alleviate pain Sedation PRN bed cradle Childproof |
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Teaching for hemophilia
|
Genetic counseling
Medic alert tag Remove sources of potential injury Allow child to develop Helmets, padding Watch diet, obesity strains joints |
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This emergent disorder causes small blood vessel blockage, causing organ tissue damage, leading to severe hemorrhage
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DIC
|
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Clotting and hemorrhage happen at the same time in
|
DIC
|
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S/S of DIC
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abnormal bleeding w/o hx of serioud hemorrhage disorder
cutaneous oozing petechiae or blood blisters bleeding from surgical sites, IV's, GI tract N/V Shock, confusion |
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Initially the bleeding is subtle bit it can develop into massive hemorrhage from kidneys, brain, heart and other organs in
|
DIC
|
|
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DIC lab values
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Decreased platelets, fibrinogen, Hgb
Increased PT, PTT (60-80sec), Thrombin time |
|
|
# 1 goal in tx DIC is to
|
Identify the cause,
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Tx of DIC
|
Tx underlying cuase, control bleeding, restore normal clotting factors
|
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Secondary goals for tx DIC
|
Correct tissue ischemia by improving oxygenation, replacing fluid and admin vasopressor
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|
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Active bleeding in DIC requires administration of
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Fresh frozen plasma, platelets, whole blood, volume expanders or PRBC's
|
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________is given in DIC to replace fibrinogen and factors VIII and V
|
cryoprecipitate
|
|
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This is controversial in DIC it may be used early to prevent micro clotting and help perfusion to organs
|
Heparin
|
|
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Nursing mgmt for DIC
|
Monitor bleeding, labs
Prevent injury NO IM injections Apply pressure Admin blood products |
|
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Nursing dx for DIC
|
FVD
Impaired skin integrity Alteration in renal perfusion |
|
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Prognosis in DIC
|
Mortality rate can exceed 80%
|
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Types of leukocytes
|
Neutrophils (60-70)
Lymphocytes(20-40) Monocytes(2-6) Eosinophils(1-4) Basophils (.5-1) Basophils |
|
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Granulocytes
|
Basophils
Eosinophils Neutrophils |
|
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Agranulocytes
|
Lymphocytes
Monocytes |
|
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This phrase is used to describe an increase number of immature neutrophils, occurs in toxemia, hemorrhage or leukemia
|
Shift to the left
|
|
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Immature cells undergo an abnormal transformation giving rise to _______ cells
|
leukemic
|
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In the US about_______people develop leukemia annually, it is more common in med and whites
|
28,000
|
|
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A reduction in the number of blood cells produced by all cell lines is called_____
|
Pancytopenia
|
|
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An insufficient number of normal blood cells results in
|
Anemia, pallor, fatigue, infection and bleeding
|
|
|
This test confirms a dx of leukemia
|
Bone marrow aspiration
|
|
|
Dx tests in leukemia
|
H and P
CBC WBC LP CT |
|
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Tx for leukemia
|
Chemo
Radiation Bone Marrow transplant |
|
|
Types of BMT
|
Autologous
Allogeneic Synegenic |
|
|
The pts own marrow harvested during period of remission
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Autologous
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|
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This bone marrow is from another person
|
Allogeneic
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|
|
You need a _____match for bmt success
|
HLA (Human Leukocytic Antigen)
|
|
|
This is considered the standard tx for leukemia and many other cancers
|
BMT
|
|
|
Dietary needs for leukemia
|
Low microbial
|
|
|
A leukemia:
most common form in adults, all ages, decrease in RBC's and platelets, survival low if not tx. Prognosis better w bmt |
AML (Acute Myleocytic Leukemia)
|
|
|
A leukemia:
Incidence rises w age, rarest type, may be due to Philadelphia chromosome, death from infection and hemorrhage. |
CML (Chronic Myleocytic Leukemia)
|
|
|
Drugs of choice for CML
|
Busulferan (Myleran) Leukeran alone or w steroids
|
|
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A leukemia:
Most common in young children, male more, wt loss, petechiae, bruising w/o cause, initial wbc below 10,000 |
ALL (Acute Lymphocytic Leukemia)
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Rx for ALL
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6mercaptopurine, vincristine, prednisone, ARA-C
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A leukemia:
Disease of elderly 50-70, mild, may require no tx, found on routine exam |
CLL (Chronic Lymphocytic Leukemia)
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Rx for CLL
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Leukeran po
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Nursing mgmt for leukemia
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Infection
Bleeding Pain Nutrition Psychological support |
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Be alert for changes in _____ in pts with leukemia
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LOC
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This is a neoplastic disease of the lymphatic system characterized by proliferation of abnormal cells call reed-sternberg cells
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Hodgkin's disease
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In hodgkins disease _____% live at least 5 yrs with tx
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90
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Hodgkins S/S
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Enlarged lymph nodes (cervical are first)
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Hodgkins assessment
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Painless enlarged cervical lymph nodes, persistent cough, pruritis (for months, may be 1st and only sx) fever wt loss, sob, neuralgia, dysphagia
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This may be the first and only sx that lasts months in hodgkins
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Pruritis
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Dx tests for hodgkins
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H and P, CBC, sed rate, liver enzymes, WBC and eosinophils are elevated, bone marrow exam, ct
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Limited to a single node 90-98% survival
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Stage 1
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2 or more nodes on same side of diaphragm 70-80% survival
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Stage 2
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Disease on both sides of diaphragm sometimes spleen 50% survival
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Stage 3
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One or more lymph organs, bones, lungs, skin, GI, liver
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Stage 4
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In stage______ and _______ total nodal radiation from the mastoids to the femorals is done
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3 and 4
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Most widely use combo of chemo and radiation
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MOPP
mechlorethamine oncovin prednisone procarbazine |
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Goal in tx hodgkins is
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cure, regardless of stage
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This type of lymphoma is associated with AIDS, immunosuppressive therapy for organ transplant
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Non Hodgkins
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May have advanced disease at time of dx.
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Non hodgkins
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Primary sites of non hodgkins
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GI, ovaries, testes, SQ tissue, bone, CNS, liver, and breast
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This is the most serious and prevalent of the plasma cell dyscrasias. Affects 28 out of every 100,000 americans yearly
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Multiple myleoma
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Cause by abnormal proliferation of plasma cells in the bone marrow.
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Multiple myleoma
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Characterized by multiple malignant masses located throughout the skeletal system
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Multiple myleoma
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Classic sx of Multiple myleoma is
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Bone pain, usually in the back or ribs
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Dx of Multiple myleoma
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CT shows punched out lesions and osteoporosis, Bone marrow biopsy, CBC, 24 hr urine
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Is there a cure for Multiple myleoma
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No
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These are increased in Multiple myleoma
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Calcium and uric acid which impair renal function
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________ is the primary mode of tx for Multiple myleoma
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Chemo
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Nursing mgmt in Multiple myleoma
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Pain
Mobility s/s of hyper calcemia promote safety 3000-4000 liq per/day decrease calcium to prevent renal damage |
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Cancer cells can affect the immune system by 3 things
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Stimulating the release of T lymphocytes into circulation. Suppressing the pts natural defenses. and mobilizing macrophages
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To reduce nitrate intake of possible carcinogenic action the nurse suggests that the pt decrease his/her intake of
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Ham and bacon
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An endoscopic procedure can be used to remove an entire piece of suspicous growth. The dx biopsy method used for this procedure is known as
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Excisional biopsy
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Surgery done to remove lesions that are likely to develop into cancer is known as
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Prophlactic
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An example of pallative surgery is a
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Cordotomy
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Radiation therapy for the tx of cancer is admin over several weeks to?
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Allow time for repair of healthy tissue
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A pt with uterine cancer is being tx with internal radiation. A primary nursing responsibility is to?
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Explain to the pt that she will continue to emit radiation for approx. 1 wk after the implant is removed
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A major disadvantage of chemotherapy is that it?
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Targets normal body cells as well as cancer cells
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When a pt takes vincristine, a plant alkaloid, the nurse should assess for sx of toxicity affecting the ?
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Nervous system
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Initial nursing action for extravasation of chemo agents include ?
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Immediately stopping the infusion. Placing ice over the site of infiltration. and injecting an antidote if required
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Realizing that chemo can result in renal damage the nurse should
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encourage fluid intake to dilute the urine
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Allopurinol may be prescribed for the pt who is receiving chemo to
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lower serum and urine uric acid levels
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The use of hyperthermia as a tx in cancer may cause
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N/V/D, fatigue, hypotension, skin burns, tissue damage, thrombophlebitis, and peripheral neuropathy
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BCG is a non specific biologic response modifier that is a standard form of tx for cancer of the
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Bladder
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The nurse should assess a cancer pts nutritional status by
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weighing the pt daily
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The most freq. occurring gram positive cause of infection in cancer pts is
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Staph
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The most common cause of bleeding in cancer pts is
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Thrombocytopenia
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The single most lethal chemical carcinogen is
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Tobacco smoke
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List 5 sx of extravasation
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Redness, pain and swelling
Mottled appearance Phlebitis, loss of blood return Resistance to flow, tissue necrosis |
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This drug can cause bone marrow suppression
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vincristine
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5-FU can cause
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N/V/D
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Stomatitis and alopecia are common with this drug
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cisplatin
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This cancer drug can cause hepatotoxicity
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asparaginase
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Two major gram nevative bacilli that cause infection in an immunosuppressed pt are
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pseudomonas aeruginosa and E. coli
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A physicain expects that the pt has a deficiency in the leukocyte responsible for cell mediated immunity. The nurse knows to check the WBC count for
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T lymphocytes
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Myeloid and lymphoid stem cells produce specific types of blood cells. The nurse knows when evaluating blood tests that myeloid stem cells differentiate into
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erythrocytes
leukocytes platelets |
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The nurse notes that the pt is a vegetarian, has an abnormal number of megaloblasts, the nurse suspects a deficiency in
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Vit B12
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An elderly pt presents with c/o exhaustion. The nurse aware that the most common hematologic condition affecting the elderly knows to check the pts
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RBC count
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A nurse who cares for a pt who has experience bone marrow aspiration to biopsy should be aware that the most serious hazard is
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hemorrhage
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A person can tolerate a gradual reduction in hemoglobin until the leve reaches
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2.0-2.5g/dL
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The nurse begins to design a nutritional packet of info for a pt dx with iron deficiency anemia, the nurse would suggest and increased intake of
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organ meats
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Georgia is prescribed spironolactone (Aldactone) 50mg once per day. The nurse knows that spironolactone
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inhibits renal vasoconstriction, which prevents the release of renin
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OTC iron preparation must be taken for how many months for iron replenishment to occur
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6-12 months
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The most frequent symptom and complication of anemia is
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fatigue
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The cause of aplastic anemia may be r/t
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drugs, chemicals, radiation, infection or ideopathic
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During a routine exam of a pt with anemia the nurse notes the pts beefy red tongue. The nurse knows that this is a sx of what kind of anemia
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megaloblastic
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A nurse should know that a dx of hemolytic anemia is assoc with
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Abnormality in the circulation of plasma. Defect in the erythrocyte, and elevated indirect bilirubin
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Absence of intrinsic factor is assoc with vit B12 deficiency because the vitamin cannot bind to the transported for absorption in the
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ileum
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A dx sx of pernicious anemia is
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a smooth, sore, red tongue
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A schilling test is used to dx
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pernicious anemia
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A nurse expect a pt with sickle cell anemia to have a hemoglobin of
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between 7-10 g/dL
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This disease can cause cellular blockage in small vessels, decreased organ perfusion, tissue ischemia and infarction and pain
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Sickle cell disease
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A person with sickle cell trait would have
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chronic anemia
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Polycythemia vera is characterized by bone marrow overactivity resulting in clinical manifestations of
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Angina
thrombophlebitis claudication |
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A pt dx with neutropenia resulting from increased destruction of neutrophils would most likely have
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infectious hepatitis
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The common feature for leukemia is
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an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements
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Nursing assessmet for a pt with leukemia should include observation for
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fever and infection
dehydration petechiae and ecchymosis |
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The major cause of death in pts with acute myeloid leukemia is believed to be
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infection
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Multiple myeloma is a
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malignant disease of plasma cells that affects the bone and soft tissue
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The classic presenting symptom of multiple myeloma is
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bone pain in the back of the ribs
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A pt is admitted with thrombocytopenia caused by decreased platelet production, the nurse knows that this dx is most likely
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DIC
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In the normal blood clotting cycle the final formation of a clot occurs when
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fibrin reinforces the platelet plug
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Bleeding and petechiae dont usually occur w thrombocytopenia until the platelet count falls below 50,000 the normal value for platelets is
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between 150,000 and 400,000
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Hemophilia is a herediatry bleeding disorder that
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has a higher incidence in males, is assoc with joint bleeding, and is r/t a genetic deficiency of a specific blood clotting factor
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A potential blood donor would be rejected if he/she
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had received a blood transfusion within the past 9-12 months
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Each 100 mL of blood should contain _____ grams of hemoglobin
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15
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Fibrinogen levels
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200-400mg/dL
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Eosinophil levels
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1-3% WBC
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Bleeding time should be
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3-8 minutes
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Basophil levels
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0.5-1%WBC
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Hematocrit male
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39-49
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Hematocrit female
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35-45
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Hemoglobin male
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13.2-17.5
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Hemoglobin female
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11.5-16
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Lymphocyte level
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25-33% WBC
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PT INR
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0.9-1.2
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PTT
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25-35 seconds
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PT
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11-15 seconds
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Thrombin time
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11-18 seconds
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