Leukemia and Lymphoma Med Surg
Card Set Information
Leukemia and Lymphoma Med Surg
LCCC Nursing MedSurg Lymphoma Leukemia
For Exam 3
Name the Lymphoid Tissues
What are Lymphomas?
Overgrowth of Lymphoid tissues due to cancerous changes
Two types are hodgkins and non-hodgkins lymphoma
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
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
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
How are Reed Steinburg cells distinguished?
Giant cells with two nuclei upon biopsy
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)
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
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
What are the S/S of NHL?
May be asymptomatic
Lympadenopathy (swollen lymph nodes)
What is the treatment for NHL?
Radiation therapy, chemo or both
Stem cell transplant may be an option for recurrent NHL
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
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
What are the causes of Leukemias?
Exact Cause is unknown
Exposure to chemicals or radiation
Alteration in Chromosomes
Large amounts of antineoplastic drugs (chemo)
What is the "miracle" treatment for AML?
: protein kinase inhibitor that interferes with the growth of cancer cells
What are the S/S of Leukemias?
All related to bleeding, anemia and infections
Similar to the s/s of anemia
What are some nursing diagnosis' for Leukemia?
Risk for Infection
Decreased tissue perfusion due to thrombocytopenia
Alteration in Nutrition
80% of cases occur in children 2-4 y/o and rarely occurs after age 15
Good response to chemo and radiation
If untreated, 4-6 mo to live
If treated, 80-95% complete remission in children
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
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
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
How is Leukemia Diagnosed?
CBC- elevated lymphocytes
Bone Marrow Aspiration
Coagulation studies- thrombocytopenia
Chromosomal Analysis- philadelphia chromosome
Monitor Serum electrolytes
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
Promote Sleep habits
What are some side effects of radiation?
Firmness of breast
Mucocystosis- breakdown of rapidly growing cells esp in oral and GI tract
Describe the chemotherapy agent Adriamycin (Doxorubicin)
Used for soft tissue cancers and leukemia
Doses are calc'd by height and weight (60-75mg/m
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/m
Steroids may be used in conjunction to mask adverse effects
Name several chemo vesicants
Describe Vincristine (Oncovin)
Comes from the Rosy periwinkle plant
Used in many cancers, including leukemia
Inhibits cells division
Dose is 1.5-2mg/m
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)
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)
What are the E/F imbalances in TLS?
High Uric Acid
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
What is Filgrastim (Neupogen)?
A WBC stimualtor. It 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
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
What are some side effects of chemo that the nurse needs to teach and care for?
Hair loss and skin changes
Bladder and bowel changes
Pica (Eating non-food items)
*Skilled emotional support
Describe the different kinds of bone marrow transplants
: transplant from a donor, usually a genetic match like a biological sibling
: stem cells removed from patient prior to treatment and replaced after treatment
: stem cells created in a lab