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NURS 300 Ch. 34 Management of Patients With Hematologic Neoplasms

Terms in this set (84)

-Hematopoiesis is characterized by a ____________, continuous turnover of blood cells.
-Normally, the production of specific blood cells from their stem cell precursors is carefully regulated according to the body's ____________.
-If the mechanisms that control the production of these cells are disrupted, the cells can proliferate excessively, as seen in the development of hematologic ____________.
-As is true with ____________ ____________disorders, the pathophysiologic processes that undergird the development of hematologic neoplasms are complex.
-Hematopoiesis is characterized by a rapid, continuous turnover of blood cells.
-Normally, the production of specific blood cells from their stem cell precursors is carefully regulated according to the body's needs. If the mechanisms that control the production of these cells are disrupted, the cells can proliferate excessively, as seen in the development of hematologic neoplasms.
-As is true with nonmalignant hematologic disorders, the pathophysiologic processes that undergird the development of hematologic neoplasms are complex.
-____________is a neoplastic proliferation of a particular cell type (granulocytes, lymphocytes, or infrequently erythrocytes or megakaryocytes).
-The defect originates in the hematopoietic ____________cell, the ____________, or the ____________stem cell.
-____________are neoplasms of lymphoid tissue, usually derived from ___ lymphocytes.
-____________ ____________is a malignancy of the most mature form of B lymphocyte—the plasma cell.
-Leukemia is a neoplastic proliferation of a particular cell type (granulocytes, lymphocytes, or infrequently erythrocytes or megakaryocytes).
-The defect originates in the hematopoietic stem cell, the myeloid, or the lymphoid stem cell.
-Lymphomas are neoplasms of lymphoid tissue, usually derived from B lymphocytes.
-Multiple myeloma is a malignancy of the most mature form of B lymphocyte—the plasma cell
Clonal Stem Cell Disorders
-When some hematologic neoplasms develop, hematopoietic control mechanisms may be in place to continue to produce adequate ____________ of normal blood cells.
-These are commonly referred to as ____________ neoplasms, where the ____________numbers of cells produced from a culprit clone all have the same ____________
-However, at some time, the control mechanisms may fail and the "indolent" clone may then evolve into a more ____________ clone
-When some hematologic neoplasms develop, hematopoietic control mechanisms may be in place to continue to produce adequate numbers of normal blood cells.
-These are commonly referred to as indolent neoplasms, where the increased numbers of cells produced from a culprit clone all have the same genotype
-However, at some time, the control mechanisms may fail and the "indolent" clone may then evolve into a more aggressive clone
Leukemia
-The term leukocytosis refers to an ____________ level of ____________ (____________blood cells) in the circulation.
-Typically, only ____________specific cell type is increased; Because the proportions of several types of leukocytes (e.g., eosinophils, basophils, monocytes) are small, an increase in other types can be great enough to elevate the total leukocyte count, particularly the ____________ or ____________.
-The term leukocytosis refers to an increased level of leukocytes (white blood cells [WBCs]) in the circulation.
-Typically, only one specific cell type is increased; Because the proportions of several types of leukocytes (e.g., eosinophils, basophils, monocytes) are small, an increase in other types can be great enough to elevate the total leukocyte count, particularly the neutrophil or lymphocyte.
Leukemia
-Although leukocytosis can be a ____________ response to increased need (e.g., in acute infection), the elevation in leukocytes should ____________ as the physiologic need ____________.
-A ____________ or progressively ____________ elevation in leukocytes is abnormal and should be evaluated.
-A significant cause of persistent leukocytosis is hematologic ____________ (i.e., leukemia).
-Although leukocytosis can be a normal response to increased need (e.g., in acute infection), the elevation in leukocytes should decrease as the physiologic need decreases.
-A prolonged or progressively increasing elevation in leukocytes is abnormal and should be evaluated.
-A significant cause of persistent leukocytosis is hematologic malignancy (i.e., leukemia).
Leukemia
-The common feature of the leukemias is an unregulated ____________ of leukocytes in the____________ ____________.
-In acute forms (or late stages of chronic forms), the proliferation of leukemic cells leaves little room for ____________ cell production.
- There can also be a proliferation of cells in the ____________ and ____________(extramedullary hematopoiesis).
-With acute forms, there can be infiltration of leukemic cells in other organs, such as the ____________, ____________ ____________, ____________, and __________.
-The common feature of the leukemias is an unregulated proliferation of leukocytes in the bone marrow.
-In acute forms (or late stages of chronic forms), the proliferation of leukemic cells leaves little room for normal cell production.
- There can also be a proliferation of cells in the liver and spleen (extramedullary hematopoiesis).
-With acute forms, there can be infiltration of leukemic cells in other organs, such as the meninges, lymph nodes, gums, and skin.
Leukemia
-The leukemias are commonly classified according to the stem cell line involved, either ____________ (referring to stem cells that produce ____________) or ____________ (referring to stem cells that produce ____________ blood cells).
-They are also classified as either acute or chronic, based on the time it takes for ____________ to evolve and the ____________ of cell development that is ____________ (i.e., with few leukocytes differentiating beyond that phase).
-The leukemias are commonly classified according to the stem cell line involved, either lymphoid (referring to stem cells that produce lymphocytes) or myeloid (referring to stem cells that produce nonlymphoid blood cells).
-They are also classified as either acute or chronic, based on the time it takes for symptoms to evolve and the phase of cell development that is halted (i.e., with few leukocytes differentiating beyond that phase).
Leukemia
-In acute leukemia, the onset of symptoms is ____________, often occurring within a few weeks.
-Leukocyte development is halted at the ____________ phase, and thus most leukocytes are ____________ cells or ____________.
-Acute leukemia can progress rapidly, with death occurring within ____________ to ____________ without aggressive treatment.
-In acute leukemia, the onset of symptoms is abrupt, often occurring within a few weeks.
-Leukocyte development is halted at the blast phase, and thus most leukocytes are undifferentiated cells or blasts.
-Acute leukemia can progress rapidly, with death occurring within weeks to months without aggressive treatment.
Leukemia
-In chronic leukemia, symptoms evolve over a period of ____________ to ____________, and the majority of leukocytes produced are ____________.
-Chronic leukemia progresses more ____________; the disease trajectory can extend for years.
-In chronic leukemia, symptoms evolve over a period of months to years, and the majority of leukocytes produced are mature.
-Chronic leukemia progresses more slowly; the disease trajectory can extend for years.
Leukemia, Complications
-anemia
-infection
-bleeding
-weakness
-fatigue
Leukemia, Nursing Diagnosis
1. Risk for ____________ and/ or ____________
2. Impaired ____________ ____________membrane
3. Imbalanced ____________ and fluid ____________
4. Acute ____________
5. ____________ and ____________ intolerance
1. Risk for infection and/ or bleeding
2. Impaired oral mucous membrane
3. Imbalanced nutrition and fluid volume
4. Acute pain
5. Fatigue and activity intolerance
Leukemia, Nursing Diagnosis
6. Risk for imbalanced fluid ____________
7. cc-care deficits due to fatigue
8. ____________
9. Risk for ____________ distress and ____________ deficit
6. Risk for imbalanced fluid volume
7. Self-care deficits due to fatigue
8. Anxiety
9. Risk for spiritual distress and knowledge deficit
Leukemia, Care of Patient
-____________, gentle ____________care
-____________toothbrush or if counts are low, ____________ ____________ can be used
-Oral care ____________ and ____________
-Freq, gentle PO care
-Soft toothbrush or if counts are low, mouth swabs can be used
-Oral care AC and PC
Leukemia, Care of Patient
-Pain med ____________; tx of ____________
-____________, ____________ feeds
-____________ foods at ____________ temp
-Low-____________ diet
-Pain med AC; tx of nausea
-Sm, freq feeds
-Soft foods at moderate temp
-Low-microbial diet
Leukemia, Care of Patient
-easing pain/ discomfort:
=____________ for fever/ myalgias
=____________ water sponging
=Freq ____________ changes
=Gentle ____________
=____________ techniques
=Decrease ____________ /____________ intolerance
=Balance ____________/ ____________
=Tylenol for fever/ myalgias
=Cool water sponging
=Freq bedding changes
=Gentle massage
=Relax techniques
=Decrease fatigue /activity intolerance
=Balance activity/ rest
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