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22 Cards in this Set

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