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  1. What causes leukemia?
    What happens in the marrow and lymph nodes?
    What happens as a result?
    • Not known; but maybe genetics or hx chemo or radiation
    • too many leukocytes in bone marrow and LNs
    • immature cells go into bloodstream, infiltrate and damage bone marrow, lymph, spleen, CNS, organs, everywhere
  2. How many types of leukemia are there?
    What does myelogenous mean?
    • 4.
    • Acute: lymphocytic (ALL), Myelogenous (AML)
    • Chronic (CLL), (CML)
    • Myleogenous- refers to nonlymphocytic groups of WBCells, granulocytes, monocytes, platelets
  3. Leukemia- how does the bone marrow fail?
    Clinical manifestations?
    What are they predisposed to?
    • -Overcrowding of weird cells and not enough normal ones/abnormal WBC production
    • -splenomegaly, lymphadenopathy, hepatomegaly, bone pain, meningeal irritation, oral lesions, bleeding, petechiae
    • -Predisposed to anemia, thrombocytopenia
  4. Leukemia
    What are the diagnostic tests?
    • WBCs- low, high or way high
    • anemia, thrombocytopenia,
    • biopsy of bone marrow (immature leukocytes)
    • CXR- may show nodal involvement, bone and lung changes
    • lymph node biopsy- immature cells in excess
  5. Leukemia- management besides controlling sx, pain control, and emo care?
    • Eradication- chemo, radiation, marrow xplant
    • Prev of inf- watch for sx- neutropenic prec (leukopenia can be fatal)
    • Thrombocytopenia- prev, watch for bleeding
  6. Leukemia- what's the prognosis
    in kids with chemo?
    • 4-6 months
    • chemo helps kids
    • - ALymphocyticL 5 year survival rate 50%
    • -AMyelogenousL remission can be 75%
    • -CLymphocyticL is variable early stages 10-12 years, late stages 18 months
    • Adults w AML, 5 year remission in 25%
  7. What can cause coagulation disorders?
    • trauma,
    • vessel damage or inedequacy
    • platelet or clotting factor malfunction
    • liver disease (impairs clotting mechs)
  8. What are clinical manifestations to assess of coagulation disorders?
    itching, petechiae, epistaxis, gingival bleeding, hypovolemia, tension (and bleeding), pale, cold clammy skin, tachycardis, GI bleed, ABD pain, internal bleeding, CNS affected due to hypotension, H&P including recent trauma, exposure to tox, meds, radiation
  9. dx/coag disorders- what tests are done?
    How is it managed/interventions?
    • CBC (spec platelet count, Hgb, HCT), coag profile, liver profile, BMarrow studied
    • Try and treat underlying cause (med induced?), xfusion of blood or blood products, treat stuff like hypotension, prevent trauma
  10. Coag disorders-
    Thrombocytopenia- what is it?
    What is ITP/Immune thrombocytopenic purpura?
    low # circ platelets or a change in their function. Less than floor; 150,000 mm3

    • ITP- most common cause of acquired- autoimmune.
    • plts coated in antibodies, function normally. ABs make plts look foreign to spleen, macrophages destroy them
  11. What meds can induce thrombocytopenia and how long until the plt count returns to normal?
    Heparin, penicillins, aspirin, oral hypglycemics, digoxin, sulfonamides, furosemide, thiazide, NSAIDS
  12. What tests dx thromocytopenia?
    what are s/sx?
    CBC (platelet), peripheral blood smear, bleeding time, bone marrow biopsy to rule out anemia

    recent viral infections may cause it petechiae and bruising, bleeding risk, mucous membranes, old puncture sites, less than 5000 mm3 can cause spontaneous bleed
  13. What are mgmt and interventions for thrombocytopenia?
    ITP: IV Ig; corticosteroid and or immunosuppressants, splenectomy (80% benefit), xfusion of platelets if active bleeding (otherwise if platelets less than 20,000), plasmapheresis, be careful, limit sticks
  14. Hemophilia
    cause? sex?
    What is Hemophilia A? What is Hemophilia B?
    • genetic
    • male
    • 85% of H/factor 8 missing (prothrombin to thrombin)
    • Factor 9 is missing (plasma protein)
  15. Hemophilia
    clinical manifestations?
    Internal, external bleeding. Larger ecchymotic areas, bleeding into joint space- hallmark of the disease, knees, ankles, elbow, painful, edema, fever
  16. Hemophilia, dx tests?
    Mgmt and interventions?
    coag times, abnormal PTT, check for factor 8 and 9 def

    • prev bleeding, pain relief, admin of factor 8 and 9, cryoprecipitate (8), factors pooled from 1000s of donors, now engineered factors avail. No ASA or aspirin at home, transfuse prior to surgery.
    • Other than HIV, prognosis good
  17. von Willebrand's Disease

    Common with? etc
    Treat with?
    • genetic, men and women
    • mild factor 8 def, slow coag time. Common post partum, menorrhagia, post surg, trauma

    spontaneous GI bleeds

    • Cryo, FFP, Factor 8
    • DDAVP-desmopressin (vasopressin) release factor 8
  18. Disseminated Intravascular coag (DIC)
    How does it cause problems?

    What happens in small vessels?

    What happens to clotting factors?
    very bad. overstim of clotting process, xfusion reactions, shock, septicemia, desease or injury, obstetric complications

    widespread clots for within them

    clotting factors are depleted- bleeding, clotting, bleeding
  19. DIC
    Clinical manifestations

    dx tests?
    bleeding- anywhere, dyspnea, diaphoresis, mottled extremities

    elevated D-Dimer (reveals the breakdown of fibrin, degree of fibrinolysis), coag profile, platelets, factor profile
  20. DIC
    med mgmt
    • fix underlying cause, admin blood products and factors
    • maybe heparin- stops form of microemboli, inhibits thrombin act, still controversial
    • protect pt from potential (even oral care)
    • prognosis varies
  21. Multiple myeloma
    What is it?
    Review on own: clin manifestations, assessment, dx tests, mgmt, interventions, prog, drugs
  22. Shock is______
    inadequate tissue perfusion
  23. Hypovolemic
    dec in fluid volume shock
  24. cardio shock
    pump failure
  25. anaphylactic shock
    hypersensitivity reaction shock
  26. Septic shock
    infection shock
  27. Shock sx

    sx hypovolemic shock
    restlessness, anxiety, disorientation, syncope, often dec urine output,

    cool and clammy skin, thready pulse + tach combined w reduced bp, cold, moist, pale, or cyanotic skin
  28. post op shock interventions
    O2, raise pt legs above h level, increase IV fl unless contra, notify anesthesia person and surgeion, provide meds as ordered, continue to assess pt and respond to interventions

    • ABCs
    • modified trendelenburg
    • warm and dry
    • IV fluids
    • blood/blood products
    • NPO
    • no pain meds
  29. how often post op inc spiretrom?
    Q 1-2h
  30. Post surg, check on pt (VS) q______
    No pillow under head until__________
    Either position_______or at a_________
    Report any _________ emesis immediately
    • 4h q15, 4h q30, 4h q1h, then q4h etc
    • fully conscious
    • on side, 45deg angle
    • red or coffee ground
  31. Evisceration, what to do
    cover wound w warm sterile moistened sterile towel. Place in fowler's pos w knees slightly flexed, reassure, tell her surg will be req, prep pt for surgery, sterile tech precedures
  32. opioids w mixed ag and antag act
  33. Aspirin, ibuprophen
  34. dipyridamole
  35. Clopidogrel Bisulfate
    IIB/IIIA blockers
  36. Thrombolytic
  37. multiple myeloma
    Clinical Manifestations
    Diagnostic tests
  38. precipitating causes of dic
  39. Hodgkin’s Disease vNon-Hodgkin’s Disease
  40. Hodgkin’s Disease
    • Untreated less than 5 years
    • Stage I-II is 90% curable

    • Peripheral blood studies – anemia
    • Bone scan
    • Increased WBC
    • Abnormal ESR (Erythrocyte Sedimentation rate)
    • CXR reveal a mediastinal mass
    • CT scan & biopsy – organ & nodal involvement
    • Bone marrow biopsy stages
    • Presence of Reed-Sternberg cells!
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