CELLULAR REGULATION

Stem Cell Transplant

-Chemo/radiation destroys all leukemic & stem cells in pt's body -stem cells from donor, cord blood *very immunosuppressed during this therapy/reverse isolation* Nursing: -prevent/monitor for infection -NO live vaccines

Breast Cancer Causes & Risks

-Female over 50/postmenopausal -Family Hx -Personal Hx -ovarian/uterine -Genetic Mutation: BRCA LIFESTYLE RISK -wt gain, obesity -PO contraceptives --estrogen & progesterone -Diet ↑fat, ↓fiber -Alcohol & drinking

Acute leukemias (ALL and AML)

-Immature, nonfunctional WBCs -Acute = Abrupt onset -common in children

Leukemia Symptoms

-Infections -Fatigue/Anemia/Pallor - unsteady gait -Bruising - petechiae, easy bleeding -wt loss, anorexia -bone pain = ↑WBC

Chronic leukemias (CLL and CML)

-Mature cells with reduced function -slow onset (insidious) -Older Adults

Acute Lymphocytic Leukemia (ALL)

-Most common in children. Adults over 70 -Rapid Onset →fever, fatigue, pale, anemic, infections, bone pain, wt loss -Prognosis: >90% remission -Treatment → chemo, bone marrow or stem cell transplant

Chronic Myelogenous Leukemia (CML)

-men ages 25-60 -Philadelphia chromosome marker -No early s/s →splenomegaly, wt loss, heat intolerance, bleeding, ↓platelets TX: interferon/chemo

Chronic Lymphocytic Leukemia (CLL)

-most common chronic adult leukemia -patient may feel well for years without needing treatment -Gradual onset, vague symptoms →lymph node enlargement, malaise, fatigue, infections TX: bone marrow transplant

Breast Cancer

-the most common cancer in women -2nd leading cause of death

Leukemia

-too many immature WBC's. Can't protect the body -Infections -Anemia -Bleeding -hypermetabolism -Infiltration & replacement in: liver, spleen, CNS, bone marrow, other organs *more common in ppl exposed to radiation or chemical agents *treated for other cancers

Chemo therapy pt vomits!!!-7 steps

1-wash hands with soap and water 2- get spill kit from pt's room 3-Put on face mask 4-put on gown 5- Gloves 6-googles 7-use absorbent pads to wipe up spill clean floor X3 with detergent

Chemotherapy phases

1. Induction Therapy: multiple chemo meds Goal: Reduction of disease 2. Intensification Therapy: 2md round of chemo to eradicate any remaining cells 3. Maintenance therapy: monthly chemo to maintain remission stem cell transplant bone cell transplant

The nurse is teaching the client who is undergoing induction therapy for leukemia. The nurse realizes the client needs additional instruction when the client makes which statement? "I will have to pace my activities with rest periods." "I cannot wait to get home to my cat!" "I will use a warm saline gargle instead of brushing my teeth." "I must report a temperature of 100°F (37.7°C)."

"I cannot wait to get home to my cat!" The nurse identifies that the client does not understand that contact with animals must be avoided because they carry infection, and the induction therapy will destroy the client's white blood cells (WBCs). The induction therapy will cause anemia, and the client will experience fatigue and will have to pace activities with rest periods. Platelet production will be decreased, and the client will be at risk for bleeding tendencies; oral hygiene will have to be provided by using a warm saline gargle instead of brushing the teeth and gums. The client will be at risk for infection owing to the decrease in WBC production and should report a temperature of 100°F (37.8°C) or higher.

Mastectomy post-op

Elevate arm prevention of hematoma support and education assess for infection bleeding -JP Drain - over 100mL bright red ---can remove when <25mL after 24 hours -Monitor for shock/hemorrhage

Mastectomy Teaching

Avoid Affected Arm -No IV or blood draws -No vaccines -No BP Prevent Swelling -compression sleeve -elevate arm -exercises Normal -numbness -lymph node swelling

Most Dangerous Chemo Side Effect

Bone Marrow suppression -↓RBC & Low CBC = Anemia ---Normal: 4.5-6 -↓Platelets --Normal: 150-400,000 ---↓100,000 = thrombocytopenia -↓WBC - Leukopenia <4,000 ---Normal: 5,000-10,000

Leukemia chemo complications

INFECTION-reverse isolation. No live vaccines BLEEDING-platelet infusion ANEMIA-iron infusions PAIN-treat source, pain mgmt N&V -meds b4 treatments Anorexia Mucosal Ulceration -gums, anal Neuropathy Constipation Hemorrhagic cystitis - ↑fluids Alopecia Moon Face, Mood Changes - steroid therapy **mask s/s infecton

A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation? Instruct family members not share food because it isn't healthful. Offer a face mask to the person with the cold and use this as an opportunity for further teaching. Tell family members to be careful to avoid the child if they're sick. Post isolation signs on the child's door and carefully assess the health status of all visitors.

Offer a face mask to the person with the cold and use this as an opportunity for further teaching. Offering a face mask is the best approach; it protects the child while supporting the family and using the situation as an opportunity for learning. Instructing family members that it isn't healthful to share food and to avoid the child if they're sick are technically correct, but these responses don't include a rationale that enables the family to understand why these actions are important. The nurse should have posted an isolation sign on the child's door long before the time of the child's discharge.

Acute Myelogenous Leukemia (AML)

Too many myeloblasts Most common adult leukemia Symptoms: →neutropenia, thrombocytopenia, infections(PNA, sepsis), spelenomegaly, hepatomegaly, lymphadenopathy

neutropenia

a decreased number of neutrophils

Leukemia Diagnostics

bone marrow aspiration/biopsy -kids: post. iliac crest. -adults: sternum Lumbar puncture, CT scan increase in immature WBC decrease mature WBC decrease RBC & platelets

The nurse cares for a child with leukemia. Which measure is contraindicated when the nurse assists the child with oral hygiene? applying petroleum jelly to the lips cleaning the teeth with a toothbrush swabbing the mouth with moistened cotton swabs rinsing the mouth with a nonirritating mouthwash

cleaning the teeth with a toothbrush The oral mucous membranes are easily damaged and are commonly ulcerated in the client with leukemia. It is better to provide oral hygiene without using a toothbrush, which can easily damage sensitive oral mucosa. Applying petroleum jelly to the lips, swabbing the mouth with moistened cotton swabs, and rinsing the mouth with a nonirritating mouthwash are appropriate oral care measures for a child with leukemia.

A client undergoing chemotherapy after a modified radical mastectomy asks the nurse questions about a breast prosthesis and wigs. After answering the questions directly, the nurse should provide what additional information? contact information for the breast cancer support group a referral to the social worker how to contact a home health care agency when to contact a plastic surgeon

contact information for the breast cancer support group

Polycythemia

excess of red blood cells

Thrombocytopenia

low platelet count Bleeding risk: →Petechiae, Purpura, Ecchymosis, Epistaxis, Gingival Bleeding, Menstrual Abnormalities, Menstrual Abnormalities, GI Bleeding, Hemorrhage

Leukemia symptoms

pallor, fatigue, fever, anorexia bruising, petechiae wt loss, muscle wasting chronic infections enlarged liver, spleen, lymph nodes pain, fractures H/A, stiff neck irritability, lethargy, pupillary changes

Leukemia Labs

↑WBCs - immature. Crowd out production of RBCs & platelets ↓H&H ↓Platelets - bleeding