Leukemias AL BRGSON

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a group of malignant disorders affecting the blood, bone marrow, lymph system, and spleen

leukemias

describe the difference between acute VS chronic leukemias. what 2 types of WBCs are involved in leukemias?

acute- proliferation of immature hematopoietic cells called blasts, rapid onset of dz process
chronic- proliferation/overgrowth of mature WBCs, gradual onset of dz process
myelogenous origin vs lymphocytic origin

The clinical manifestations for leukemias vary depending on the type of leukemia, b ut in general there is bone marrow failure due to _____ & leukemic ___ of the organs

due to pancytopenia
leukemic infiltrates of the organs

The goal of the diagnostic studies is to define the type of leukemia present and the studies used in general for leukemias are ____, ____, ___ & ____

bone marrow exams
blood word- CBC
lumbar puncture
CT

Acute Myelogenous Leukemia (AML) is a rapid overgrowth of _____, that occurs in adults ages ___ to ___, which presents clinically as manifestations of ____ & ____ at onset of the disease. Diagnostically you will see hyper cellular bone marrow with _____, and decreased ___, ___, & ____.
It is also interesting to note that AML may be caused by a progression of what disease process?

myeloblasts
60-70yos
serious infection & abnormal bleeding
myeloblasts
platelets, RBCs, H/H
possibly a progression of MDS

Acute Lymphocytic Leukemia (ALL) is a rapid overgrowth of _____, most commonly in those people <____ years old, showing most common symptoms of ____, ____, & _____.
Diagnostically ALL shows hypercellular bone marrow with _____ & it may also be necessary to do a _____ to determine whether CSF fluid contains lymphoblasts.

lymphoblasts
<14 (peaks at 2-9)
fever, bleeding, & CNS manifestations (increased ICP may show up as N/V and lethargy)
lymphoblasts
lumbar puncture

If an ALL patient develops leukemic meningitis it may be necessary to treat the patient with ____.
A lot of pt's with ALL will be treated with prophylactic ____ in order to prevent CNS manifestations of the dz process.

cranial radiation

prophylactic intrathecal methotextrate

MARYS WAY TO REMEMBER ALL

ALL- All babies are crazy b/c CNS manifestations.

Chronic myelogenous leukemia (CML) is a gradual overgrowth of _____, most commonly occurring in adults from ___ to ___ years of age.
Although CML patients don't experience symptoms early on in the disease process, they will see massive ____ & ____ later on.
Diagnostically you will see ___ in the bone marrow, liver, and spleen and the disease marker _________.

neoplastic granulocytes (BEN "Phils" Basophils, Eosinophils, Neutrophils)
25 to 60 yos (rare to occur <30yo)
massive splenomegaly & increase in sweating later on
granulocytes
Philadelphia Chromosome

MARYS WAY TO REMEMBER CML

CML- C M Leukemia
Cure My Luck, Philadelphia
My spleen and liver are huge!

CML disease follows a pathway of phases beginning with a ____ stable phase that can last for several years & even with treatment this phase will eventually progress to the second ____ phase, & eventually it will enter the more acute, aggressive ____ phase ****IN WHICH THE DISEASE PROCESS BECOMES REFRACTORY TO TREATMENT****

1- chronic stable phase
2- accelerated phase
3- BLASTIC PHASE*****

Chronic Lymphocytic Leukemia (CLL) HAS THE BEST PROGNOSIS OF ALL LEUKEMIAS & consists of a gradual overgrowth of ____ that occurs mostly in predominantly ____ adults from ___ to __ years old. Although CLL patients frequently show no symptoms, detection of the disease is often made during exam for another unrelated conditions. Some SSX that you may see are ___ enlargement throughout the body & frequent ___.

lymphocytes
predominantly male adults 50 to 70years old
lymph node enlargement throughout the body
& frequent infections

Diagnostically, a patient with CLL, would show an increase in the total # of WBCs >____ & ____ in the bone marrow, liver, spleen, and lymph nodes.

>100,000
& lymphocytes

CLL patients can experience what is known as ____ in which there is a transformation to a diffuse, large B-cell non Hodgkins lymphoma.

Richter's syndrome

with the chronic leukemias, we see more ___ of the organs

infiltration of the organs

____ is the mainstay of treatment for leukemias. ____ can be developed from the treatment for leukemias.

chemotherapy
pancytopenia

The purpose for using a combination therapy in treating leukemias is to decrease _____ resistance, minimize the drug ___ to the patient by using multiple drugs with varying toxicities, and to interrupt ___ at multiple points in the cell cycle

decrease drug resistance
minimize drug toxicity
interrupt cell growth at multiple points in cell cycle

Describe the phases of chemotherapy:
induction
intensification
consolidation
maintenance

induction- initial, agrressive chemo doses introduce in attempt to induce remission (pt may become critically ill)
intensification- high dose therapy for sever months after induction trying to eradicate bad cells
consolidation- occurs after remission, to eliminate any remaining leukemic cells not evident clinically or pathologically
maintenance- keep the body free of leukemic cells, this involves LOWER dose of the same drug administered every 3-4 weeks for prolonged period of time

When a patient receives the diagnosis of leukemia, they can expect to have ___ & ___ vaccines.

pneumonia and influenza at diagnosis (then pneumonia @5 years and influenza annually)

NCLEX: The most common type of leukemia in older adults is
a. AML
b. ALL
c. CML
d. CLL

d. CLL

NCLEX: Most drugs are often used in combination to treat leukemia and lymphoma because
a. there are fewer toxic and side effects
b. the change that one drug will be effective is increased
c. the drugs are more effective without causing side effects
d. the drugs works by different mechanisms to maximize the killing of malignant cells

d. the drugs works by different mechanisms to maximize the killing of malignant cells

NCLEX: A patient with AML is to start chemotherapy. During the induction stage of chemotherapy, the nurse can expect the patient to
a. experience mild side effects of the drugs
b. experience additive bone marrow suppression
c. receive high-dose treatment daily for several months
d. regain energy and become more resistant to infection

b. experience additive bone marrow suppression
(rationale- induction therapy is aggressive treatment with chemo agents, which often causes the patient to become devastatingly ill and predisposed to complications because the bone marrow is even further suppressed by the drugs. Induction therapy is usually administered for 10 days and may be followed by intensification therapy that involves high-dose therapy for several months.)

NCLEX: Lymphadenopathy, splenomegaly, and hepatomegaly are common clinical manifestations of leukemia that are due to
a. the development of infections at these sites
b. increased compensatory production of blood cells by these organs
c. infiltration of the organs by increased numbers of WBCs in the blood
d. normal hypertrophy of the organs in attempt to destroy abnormal cells

c. infiltration of the organs by increased numbers of WBCs in the blood
(rationale- almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and CNS by excessive WBCs in the blood.)

NCLEX: A patient with AML is considering a bone marrow transplant and asks the nurse what is involved. The best response by the nurse is
a. "Your bone marrow is destroyed by radiation and new bone marrow cells from a matched donor are injected into your bones"
b. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells then rein fused when your disease becomes worse."
c. "During chemotherapy and total body radiation to destroy all your blood cells you are given transfusions of red cells and platelets to prevent complications."
d. "all leukemic cells and bone marrow stem cells are eliminated with chemotherapy and total body radiation and new bone marrow cells from a donor are infused."

d. "All leukemic cells and bone marrow stem cells are eliminated with chemotherapy and total body radiation and new bone marrow cells from a donor are infused."

NCLEX: Nursing diagnoses that are appropriate for the patient with newly diagnosed CLL include
a. pain and hopelessness
b. anxiety and risk for infection
c. self-care deficit and ineffective health maintenance
d. decisional conflict: treatment options and risk for injury

b. anxiety and risk for infection
(rationale- a patients with newly diagnosed leukemia is most likely to respond with anxiety about the effects and outcome of the disease, and the risk of infection from altered WBCs is always present, even if other blood cells are not yet affected by the disease.)

NCLEX: A patient with leukemia develops thrombocytopenia following chemotherapy. Based on this specific finding which of the following nursing interventions is priority?
a. encourage the pt to turn, cough, and deep breathe every 2H
b. monitor the patient's temperature every 4 hours
c. monitor the patient's platelet count
d. encourage the patient to take frequent rest periods throughout the day

c. monitor the patient's platelet count

Which of the following nursing interventions and patient instructions are appropriate in caring for a patient who has pancytopenia (select all that apply)
a. restrict fresh fruits and vegetables in the diet
b. restrict visitors
c. insert a foley urinary catheter to monitor intake and output
d. restrict fluids
e. report low-grade temperature
f. hold firm pressure for 5 minutes following necessary venipunctures
g. report ANC of 2,500
h. administer Epoetin alfa (Procrit) as prescribed

a. restrict fresh fruits and vegetables in the diet
e. report low-grade temperature
f. hold firm pressure for 5 minutes following necessary
h. administer Epoetin alfa (Procrit) as prescribed

A patient with leukemia's platelet count is 10,000. BAsed on this laboratory value, which of the following is the priority nursing assessment?
a. skin turgor
b. level of consciousness
c. bowel sounds
d. breath sounds

b. level of consciousness
(rationale- the greatest risk to the patient is spontaneous bleeding, including the risk of fatal cerebral bleed, due to a platelet count less than 20,000.)

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