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22 Cards in this Set
- Front
- Back
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What is leukemia?
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broad group of malignant disorders in the bone marrow and lymph system
<15 yo males <1yo peak onset 2-6yo |
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What are the classifications of leukemia?
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Acute lymphoid leukemia (ALL)
Acute Nonlymphoid leukemia (AML) Stem cell or blast cell leukemia |
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What is the patho of leukemia?
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unrestricted proliferation of immature WBCs in the blood forming tissues of the body (liver lymph and spleen most affected)
infiltrates and replaces any cells with non-fx cells |
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What are the consequences of leukemia?
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anemia from dec RBC
infection from neutropenia bleeding from dec platelets activity intolerance ** CNS problems Hypermetabolism |
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What is the dx of leukemia?
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peripheral blood smear
LP to eval CNS involvement bone marrow aspiration pg 930 |
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What is the theraputic management of leukemia?
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chemo agents
cranial irradiation |
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What are the phases of therapy of leukemia?
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Induction: 4-6wks
CNS prophylactic therapy: intrathecal chemo Intensification (consolidation) therapy: to eradicate residual leukemic cells and prevent resistant clones Maintenance therapy: preserve remission |
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What is hematopeietic stem cell transplantation HSCT?
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stem cell transplant from donors (family or non family)
peripherial stem or umbilical cells used mainly for AML if used in ALL, induction phase must have failed |
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What are the risks of HSCT?
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mortality
Graft vs Host disease Infection Severe organ damage cure 60% |
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When are leukemia pts most suseptable to infection?
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at time of dx and relapse
immunosuppressive therapy prolonged antibiotic therapy that predisposes growth of resistant organism |
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What are the problems with drug toxicity in leukemia?
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vesicants, anaphylaxis
N/V anorexia mucosal ulceration neuropathy hemorrhagic cystitis (mesna rx) alopecia mood changes moon face |
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Are leukemia pts able to receive vaccinations?
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no live while immunocomprimised
can have inactivated: MMR Polio no varicella vaccine (family can get) |
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How is HIV/AIDS dx?
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elisa and western blot test
Polymerase chain reaction (test for infants of + moms 1-4mo) |
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What is the management of HIV/AIDS?
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prevent PCP
1yr of prophylaxis in newborns immunization if not compromised (MMR and varicella) Blood transfusion therapy HSCT |
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What are the nursing interventions for blood transfusion therapy?
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verify recipient and donors blood group
double sign VS q15mins use appropriate filter NS use blood within 30mins of arrival infuse over 4 hrs max |
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What are the infusion reactions?
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hemolytic (ABO incompatibility)
febrile rections allergic reactions (lyarengeal edema) air emboli hyperthermia electrolyte disturbances (inc K) |
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What is the process of HSCT?
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ablative therapy: chemo to eradicate unhealthy cells and suppress immune system to prevent rejection
Stem cells given to pt via IV transfusion new cells repopulate bone marrow |
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What are the family concerns with HSCT?
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no rescue procedure if cx follow hsct
will die without tx might die with tx pain infection |
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What is allogeneic bone marrow transplant?
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matching histocompatible donor with recipients
limited by sustainable donor |
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What is autologous bone marrow transplant?
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uses pts own marrow from disease free tissue, frozen, and sometimes treated to remove malignant cells
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What is autologous BMT used for?
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neuroblastoma
hodgkin disease NHL wilms tumor rhabdomyocarcoma ewing sarcoma |
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What are the benefits of umbilical cord blood stem cell transplant?
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blood relative immunodeficiency at birth, allowing for partially matched unrelated cord blood transplants to be successful
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