Leukemia and Lymphoma Med Surg

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  1. Name the Lymphoid Tissues
    • Thymus
    • Bone Marrow
    • Spleen
    • Lymph Nodes
  2. What are Lymphomas?
    • Overgrowth of Lymphoid tissues due to cancerous changes
    • Two types are hodgkins and non-hodgkins lymphoma
  3. What differentiates Hodgkins from Non-Hodgkins Lymphoma
    • Hodgkins nodules are individualized and spread in an organized fashion
    • Hodgkin nodules have Reed Steinburg Cells
    • Non-Hodgkins spreads rapidly and randomly. No Reed Steinburg cells
  4. What are the S/S of Hodgkin's Lymphoma?
    • Enlarged lymph nodes in cervical, mediastinal or supraclavicular areas (palpable, painless, rubbery and freely movable)
    • These englarged lymph nodes may become tender with alcohol consumption
    • Fatigue
    • Fever
    • Night Sweats
    • Presence of Reed Steinberg cells in nodules
    • Nodules spread in a chain of lymph nodes in an organized fashion
    • More common in teens and young adults, then in older adults >50y/o
  5. How are Reed Steinburg cells distinguished?
    Giant cells with two nuclei upon biopsy
  6. What are the causes of HL?
    • Cause is unknown, but it may be viral in origin
    • Often occurs regardless of risk factors (epstein bar, HIV, genetics, bone marrow transplantation)
  7. How is HL treated?
    • It is one of the most treatable types of cancer
    • External radiation for stages I and II
    • Combo chemo stages III and IV
  8. What is NHL?
    • Non Hodgkin's Lymphoma
    • Most commonly, there is an infiltration with malignant B cells of the lymph system
    • The cause is unknown, more common in older adults
    • May be indolent (slow growing) or aggressive and systemic
    • Does not Spread in an organized fashion
    • No Reed Steinberg Cells
  9. What are the S/S of NHL?
    • May be asymptomatic
    • Lympadenopathy (swollen lymph nodes)
  10. What is the treatment for NHL?
    • Radiation therapy, chemo or both
    • Stem cell transplant may be an option for recurrent NHL
  11. What are Leukemias?
    • Replacement of Bone marrow with malignant immature WBCs
    • They are named according to the cell they affect and whether they are acute or chronic
    • The "blast cells" (immature, abnormal WBCs) grow wildly and replace infection fighting WBCs
    • These out-crowd all other cells and cross the blood brain barrier
  12. What are the types of Leukemias?
    • Acute Lymphocytic Leukemia (ALL): Effects mostly children
    • Chronic Lymphocytic Leukemia (CLL): effects mostly elderly
    • Acute Myelogenous Leukemia (AML): normally effect adults
    • Chronic Myelogenous Leukemia (CML): Shows philadelphia chromosome abnormalities
  13. What are the causes of Leukemias?
    • Exact Cause is unknown
    • Exposure to chemicals or radiation
    • Alteration in Chromosomes
    • Large amounts of antineoplastic drugs (chemo)
  14. What is the "miracle" treatment for AML?
    • Gleevac (Imatinib): protein kinase inhibitor that interferes with the growth of cancer cells
    • -95% remission!
  15. What are the S/S of Leukemias?
    • All related to bleeding, anemia and infections
    • Similar to the s/s of anemia
  16. What are some nursing diagnosis' for Leukemia?
    • Risk for Infection
    • Decreased tissue perfusion due to thrombocytopenia
    • Activity Intolerance
    • Alteration in Nutrition
    • Pain
    • Anxiety
  17. Describe ALL
    • 80% of cases occur in children 2-4 y/o and rarely occurs after age 15
    • Good response to chemo and radiation
    • Immature lymphoblasts
    • If untreated, 4-6 mo to live
    • If treated, 80-95% complete remission in children
  18. Describe AML
    • Immature myoblasts and WBC counts vary
    • Most common in adults from adolescence to 50 y/o
    • Client is usually asymptomatic except for fatigue and bleeding
    • If untreated, survival is 2-4 months
    • If patient <60 y/o, remission is 50-75%
    • 20% complete remission after 5 years
  19. Describe CLL
    • Most common in men 50-70 y/o
    • Increasing immature lymphocytes
    • Slow growth within lymph nodes, bone marrow, liver and spleen
    • If caught early (because it's slow growing), it has a good prognosis
  20. Describe CML
    • Common men >45 y/o and elderly
    • Associated with radiation and presence of the Philadelphia chromosome (esp for radiation for prostate cancer)
    • Increase in number of immature myloblasts
  21. How is Leukemia Diagnosed?
    • CBC- elevated lymphocytes
    • Bone Marrow Aspiration
    • Coagulation studies- thrombocytopenia
    • Chromosomal Analysis- philadelphia chromosome
    • Monitor Serum electrolytes
  22. What are the nursing responsibilities for radiation?
    • MRI and CT done prior to therapy to determine location and size
    • Temporary tattoos mark the site of radiation
    • Promote exercise to combat fatigue
    • Enhance Nutrition
    • Promote Sleep habits
    • Pain control
  23. What are some side effects of radiation?
    • Fatigue
    • Skin changes
    • Firmness of breast
    • Decreased weight
    • Mucocystosis- breakdown of rapidly growing cells esp in oral and GI tract
    • Taste changes
    • Anorexia
    • Diarrhea
    • Nausea
    • Vomiting
  24. Describe the chemotherapy agent Adriamycin (Doxorubicin)
    • Used for soft tissue cancers and leukemia
    • Doses are calc'd by height and weight (60-75mg/m2) IV
    • May cause pink urine and toxic urine output
    • Very strong vessicant drug causing tissue necrosis if infiltration occurs
    • Side effects include alopecia, N/V, and bone marrow suppression
    • THERE IS A LIFETIME LIMIT ON THIS DRUG not to exceed 550mg/m2
    • Steroids may be used in conjunction to mask adverse effects
  25. Name several chemo vesicants
    • Etoposide (VePesid)
    • Vincristin (Oncovin)
    • Vinblastin (Velan)
    • Dactinomycin (Cosmegen)
  26. Describe Vincristine (Oncovin)
    • Comes from the Rosy periwinkle plant
    • Used in many cancers, including leukemia
    • Inhibits cells division
    • Dose is 1.5-2mg/m2
    • Side Effects include muscle/nerve pain, nausea and vomiting, headache, alopecia, wt loss, dry mouth, dizziness, diarrhea or constipation
    • Monitor Liver Enzymes
    • Isolation precautions (neutropenic)
  27. What is Tumor Lysis Syndrome?
    • This is an emergency!!
    • During rapid tumor breakdown, large numbers of cells are killed rapidly, spilling potassium and metabolic bi-products into the blood
    • Early recognition is key!! (check for kidney failure)
  28. What are the E/F imbalances in TLS?
    • Hyperkalemia
    • Hyperphosphatemia
    • Hypocalcemia
    • High Uric Acid
  29. What is Epoetin Alfa (Epogen)?
    • It is an RBC stimulator. It works by stimulating erythropoietin in the kidneys to produce more RBCs
    • Side effects include increased BP, flu-like symptoms and a transient rash/urticaria
    • Given subcut (At home) 3x a week or IV
    • Roll the vial DO NOT SHAKE
    • It takes 2-8 weeks for HCT levels to increase
    • Monitor Iron labs, may need suppliments
  30. What is Filgrastim (Neupogen)?
    • A WBC stimualtor. ┬áIt is a granulocyte stimulating factor from human DNA
    • It promotes growth of neutrophils and enhances function of mature neutrophils
    • Usually given at an office appointment, often after chemo
    • 1mcg/kg/day up to 6 consecutive days IV or Subcut
    • Side effects include ST depression on ECG, bone pain, thrombocytopenia and drug fever
    • It ONLY be diluted in D5W
    • It must be refrigerated and DO NOT SHAKE
    • Teach infection control
  31. Describe Neutropenic Precautions
    • Absolute neutropenia is <1,00 or an ANC of <1
    • HANDWASHING is still the most important!
    • Often called reverse isolation
    • No sick staff, no standing water, no uncooked food or fresh fruits/veg and no flowers
    • This has serious psychosocial implications for the patient
    • ASSESS for infection without the fever, due to low neutrophil count
  32. What are some side effects of chemo that the nurse needs to teach and care for?
    • Hair loss and skin changes
    • Fatigue
    • Reproductive issues
    • stomatitis/mucositis
    • Bladder and bowel changes
    • Gastric Irritation
    • Pica (Eating non-food items)
    • *Skilled emotional support
  33. Describe the different kinds of bone marrow transplants
    • Allogenic Transplant: transplant from a donor, usually a genetic match like a biological sibling
    • Autologous Transplant: stem cells removed from patient prior to treatment and replaced after treatment
    • Synergetic Transplant: stem cells created in a lab
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Leukemia and Lymphoma Med Surg
2014-04-22 01:23:38
LCCC Nursing MedSurg Lymphoma Leukemia

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