Leukemia

Question 1

what is leukemia

Answer 1

malignant neoplasm of blood forming organs

*high incidence in kids

Question 2

leukemia is characterized by

Answer 2

an abnormal overproduction of immature forms of any of the leukocytes

• interference with normal blood production
• leads to decreased RBC and platelets

Question 3

four problems r/t leukemia

Answer 3

1) anemia results d/t decreased RBC and blood loss
2) immunosuppression d/t increased # immature WBC (profound neutropenia)
3) hemorrhage d/t thrombocytopenia (low platelet ct)
4) invasion of other organs (liver, spleen, lymph, kidneys, lungs, and brain)

Question 4

normal RBC

Answer 4

4-5/6 million mcL

Question 5

normal WBC

Answer 5

4500-11000

Question 6

normal platelets

Answer 6

150,000-450,000

Question 7

diagnosis of leukemia

Answer 7

• biopsy
• bone marrow aspiration
• lumbar puncture
• frequent blood cts

Question 8

general treatment of leukemia

Answer 8

antineoplastic chemo

Question 9

causes of leukemia

Answer 9

• genetics
• ionizing radiation
• viral infections (human T cells)
• chemicals/drugs

Question 10

-inability of leukocytes to mature (those that do are abnormal)
-occurs at any time during life cycle
onset is insidious

Answer 10

Acute Myelogenous Leukemia (AML)

Question 11

prognosis for AML

Answer 11

• POOR prognosis
• 5 yr survival is 20%
• 50%n survival for kids
• cause of death tends to be d/t overwhelming infection

Question 12

• abnormal production of granulocytic cells
• biphasic disease
• young to middle aged adults

Answer 12

Chronic Myelogenous Leukemia (CML)

Question 13

prognosis for CML

Answer 13

• Poor prognosis
• 5 yr survival is 37%
  cause: ionizing radiation , chemicals

Question 14

CML stages

Answer 14

chronic stage is about 3 yrs

acute phase is about 2-3 mos

Question 15

• abnormal leukocytes found in blood forming tissue

* most common in children (most common kid cancer)

Answer 15

acute lymphocytic leukemia (ALL)

Question 16

prognosis for ALL

Answer 16

GOOD

>5 yr prognosis is 80%

Question 17

• increased production of leukocytes and lymphocytes and proliferation of cells within bone marrow, spleen, liver
• occurs after age 35 (older adults)

Answer 17

chronic lymphocytic leukemia (CLL)

Question 18

prognosis for CLL

Answer 18

GOOD

5 yr survival is 75%

Question 19

important to remember about CLL

Answer 19

often asymptomatic and NOT treated

Question 20

treatment of CML

Answer 20

• conservative, oral antineoplastic agents
• (Hydrea) Hydroxyurea- DNA synthesis inhibitor
• Interferon (unknown)
• (Gleevec) Imatinib mesylate- if cells are philadelphia chromosome positive

Question 21

leukemia nursing assessment

Answer 21

• tendency to bleed ( petechia, nosebleeds, bleeding gums, ecchymoses, nonhealing skin abrasions)
• anemia (fatigue, pallor, headache, bone/joint pain, hepatosplenomegaly)
• infection: fever, tachycardia, lymphadinopathy (swollen lymph nodes), night sweats, skin infections)
• GI distress: anorexia, abd pain, wt loss, sore throat, diarrhea

Question 22

in an immunosupressed person, infection manifests as _____

Answer 22

increased temp

• lower parametes (ie/ report if > 38.05 or 100.49)
• do thorough assessment frequently

Question 23

what is a salicylate

Answer 23

aspirin

Question 24

most oncologic drugs cause _______

Answer 24

• immunosupression
• prevent secondary infections
• stay away from people with colds
• private room
• sterile/clean environment
• no RAW veggies/fruits, ensure cooked

Question 25

interventions if immunosuppressed

Answer 25

- monitor WBC daily - assess oral cavity and genitals for yeast - monitor VS frequently - administer abx - teach/enforce infection control - oral hygiene regimen - encourage coughing and deep breathing - AVOID rectal temp - monitor fluids (encourgae 3L/day) - encourage mobility - assess for bleeding, NO salicylates

Question 26

what should the oral hygeine regimen entail

Answer 26

- soft toothbrush - no salt and soda - water soluble lubricant for lips - NO lemonglycerin swabs

Question 27

what to remember about abx

Answer 27

-notify HCP if delay in admin trough (before admin) peak (30 min to 1 hr after admin)

Question 28

this is toxic to cancer AND normal cells of both client and caregiver infusing

Answer 28

antineoplastic chemo

Question 29

who may be prohibited from administering chemo

Answer 29

if pregnant or wanting to become pregnant

Question 30

precautions with antineoplastic chemo drugs

Answer 30

- wear gloves when handling drugs | - check drug with another nurse to ensure prescription correck

Question 31

if IV cath line used for infusion...

Answer 31

verify line placement and patency with another nurse and aspirate for blood return

Question 32

if vesicant drug is administered peripherally...

Answer 32

- stay with pt and check IV placement and patency frequently, aspirate for blood return - use new side DAILY (dispose in specifically provided waste receptacle)

Question 33

extrapyramidal s/s

Answer 33

(d/t antipsychotic meds) - acute dyskinesia - parkinsonism - akinesia - akathisia - tardive dyskinesia - dystonic reactions - neuroleptic malignant syndrome

Question 34

describe ondasetron HCl

Answer 34

*zofran -prevent or relieve N/V SE: headache (give analgesic)

Question 35

how is ondasetron administered

Answer 35

30 min before chemo 1-2 hr before radiation *dilute IV injection in 50 mL NaCl

Question 36

describe granisetron

Answer 36

-relieve N/V | SE: HTN, CNS stimulation, increased LE

Question 37

assess for what if on granisetron

Answer 37

- extrapyramidal S/S - monitor liver enzymes - give only on day of chemo/radiation, 1 hr before

Question 38

describe prochlorperazine and promethazine HCl

Answer 38

-N/V | SE: drowsiness, dizziness, EP, blurry vision, dry mouth, orthostatic hypotesion

Question 39

how to administer prochlorperazine and promethazine HCl

Answer 39

- dilute if oral solution with juice * determine Baseline BP before - give deep IM - monitor BP

Question 40

describe metoclopramide HCl, Haloperidol, Diaphenhydramine

Answer 40

- N/V | - SE: drowsiness, restlessness, fatigue, EP

Question 41

what to assess for metoclopramide HCl, Haloperidol, Diaphenhydramine

Answer 41

- caution of decreased alertness * avoid alcohol - discontinue if EP s/s occur