Leukemia and Lymphoma

What are the clinical manifestations of AML?

-Fever -Infection (diarrhea, pneumonia, tonsillitis) -Weakness -Fatigue -Bleeding tendencies -Abdominal pain -Hyperplasia of the gums -Bone pain -Severe anemia

Some more facts about ALL?

-Fever is present in the majority of people at the time of Dx -S/Sx may appear abruptly or insidiously -CNS manifestations are common -Leukemic meningitis occurs in many patients

Chronic Lymphocytic Leukemia - what is it, who gets it, what is the onset like?

-Most common leukemia in adults -Increased # of b-lymphocytes which infiltrate the bone marrow, spleen and liver -Lymphadenopathy (can feel swollen lymph nodes) -Increased incidence of infection -More common in advanced age (average age is 72) -More common in men -More common in whites -Usually not seen in children

Acute Myelogenous Leukemia - what is the onset and prognosis like?

-Rarely occurs before age 40 -Abrupt and dramatic onset -Average age of onset 60-70 years -More common in men -Variable prognosis

What are thrombocytopenia precautions?

1. Avoid constipation 2. Nothing per rectum (rectal temps, suppository, enema) 3. Use an electric razor 4. No OTC meds (may contain aspirin) 5. No alcohol 6. Do not blow nose forcefully 7. Gentle mouth care 8. Avoid bending over with the head below the waist 9. Avoid IM injections

What are the diagnostic studies used for all leukemias?

1. Blood test 2. Bone marrow examination 3. Lumbar puncture 4. CT scan 5. Chromosomal studies

What is the definition "chronic" based on regarding leukemia?

1. Cell maturity 2. Nature of disease onset

What is the age and type of onset like for Chronic Myelogenous Leukemia?

1. Chronic, stable phase followed by development of acute, aggressive phase (blastic phase) 2. Age of onset 25-60 years 3. More common in men

What are neutropenic precautions?

1. Frequent hand washing 2. Strict sterile technique 3. Avoid anything invasive (Foley caths, IMs) 4. Gentle, meticulous mouth care 5. No live plants, fresh fruits or vegetables (can have them peeled and cooked) 6. No tampons (invasive) 7. Strict personal hygiene 8. Clean environment (private room, limit visitors, no one with a cold or virus or recently got a live vaccine should be allowed in) 9. No live vaccines (unless doctor wants it for some reason)

Nursing management for Hodgkin's Lymphoma can focus on managing problems related to the disease. What are these?

1. Pain 2. Skin care (radiation therapy) 3. Psychosocial considerations

Nursing considerations for leukemia?

1. Past health history; exposure to toxins 2. Meds - OTC, prescription, chemo agents 3. Comorbid conditions 4. Surgery or other treatments 5. Provide support 6. Reinforce teaching 7. Head to toe assessment 8. Monitor lab values 9. Ongoing support 10. Have they had chemotherapy in the past?

What happens in acute leukemia?

1. Rapid development of immature blood cells (that are not functioning properly) 2. Crowding in the bone marrow 3. Immediate treatment is essential

What happens in chronic leukemia?

1. There is abnormal accumulation of mature but abnormal WBCs 2. Slower disease progression (and possible better prognosis) 3. The patient is monitored before treatment

Normal platelet count?

150,000-400,000. (I know I had 140,000-500,000 before, I'm just going by the PowerPoint).

If Hodgkin's Lymphoma is found early and treated with chemo and radiation, what is the prognosis for it?

90%.

What is the platelet count in thrombocytopenia?

<50,000

What is considered a "good" platelet count for a patient on chemotherapy?

>100,000

A WBC count of ____________ is usually associated with inflammation, infection, and tissue injury?

>11,000

What are the possible causes of leukemia?

Genetic Environment Chromosomal changes Chemical agents (benzene, which is found in gas and cig smoke) Chemotherapy Virus Radiation Immunosuppression

What is the goal of a hematopoietic stem cell transplant?

Goal is to eliminate leukemic cells from the body using a combination of chemo with or without total body irradiation.

what is the big potential problem with a hematopoietic stem cell transplant?

Graft vs. Host Disease.

What is Non-Hodgkin's Lymphoma?

Group of malignant B or T cell neoplasms -B Cell 90% -T Cell 10%

Normal Hgb and HCT for males and females?

Hgb male - 14-17.4, Female - 12-16 HCT male - 42-52, Female - 36-48

What are the 2 types of lymphoma? Is it common?

Hodgkin's Lymphoma and non-Hodgkin's Lymphoma. Fifth most common type of cancer in the US.

Is the prognosis better for non-Hodgkin's or Hodgkin's Lymphoma?

Hodgkin's Lymphoma. NHL has about 40% chance of a cure.

Classification: Lymphocytes - where does the cancer change take place?

In the marrow that forms the lymphocyte cells (infection fighting cells).

Non-Hodgkin's Lymphoma can be classified as either aggressive (fast-growing) or__________________?

Indolent (slow-growing).

What type of chemotherapy is used for acute lymphocytic leukemia (ALL)?

Intrathecal. Meaning into the CNS, specifically the spinal cord.

How does Hodgkin's Lymphoma spread?

It is believed to arise in a single location and spread along adjacent lymphatics.

What is Hodgkin's Lymphoma? How common is it?

It is characterized by a proliferation of abnormal giant, multinucleated cells, called Reed-Sternberg cells, located in the lymph nodes. It accounts for 12% of lymphomas.

What happens to the normal structure of lymph nodes in Hodgkin's Lymphoma?

It is destroyed by hyperplasia of monocytes and macrophages.

How is leukemia classified?

It is first classified as either acute or chronic and then classified by the type of WBC (myelocyte or lymphocyte) that is involved.

Acute Lymphocytic Leukemia (ALL) - who it is most common in?

It is the most common type of leukemia in children. More common in boys. More common in whites and Hispanics.

Is Hodgkin's Lymphoma more common in males or females?

It is twice as prevalent in males.

Define "partial remission"?

Lack of symptoms, peripheral blood smear looks ok, still some evidence of disease in bone marrow.

Define maintenance therapy.

Lower does of drugs over prolonged period of time.

Define consolidation therapy.

Lower doses of the same drugs to decrease chances of recurrence.

What is lymphoma?

Malignant neoplasms originating in the bone marrow and lymphatic structures; results in the proliferation of lymphocytes.

Hodgkin's Lymphoma nursing management - what does it focus on?

Management focuses on selecting a treatment plan. -Least amount to achieve cure -Minimize short and long-term complications -Patient treated with combination chemotherapy aggressively 6-8 cycles -Radiation may be used as a supplement

When lymph nodes become enlarged, what do they feel like?

Movable, non-tender, and painless, The only pain would be if they were pressing on a nerve.

What are the early symptoms of Chronic Myelogenous Leukemia (CML)?

NONE. This disease has no early symptoms. A person may think nothing is wrong, go to the doctor, and find they have the Philadelphia Chromosome.

What are the values for neutropenia and profound neutropenia?

Neutropenia <1,000 Profound neutropenia <500

Define "complete remission".

No evidence of disease on physical exam, bone marrow and peripheral blood smear.

Are peripheral blood tests a good way to diagnose NHL?

No, because peripheral blood is usually normal. NHL can manifest in nonspecific ways.

If leukemia patients had a WBC count of >11,000, would they be having sx of inflammation, infection, or tissue injury? Why or why not?

No, because their WBCs do not function properly.

What is the most commonly occurring hematologic cancer? Why has it increased?

Non-Hodgkin's Lymphoma. 5th leading cause of cancer death. Incidence has increased as population has aged.

What is the primary clinical manifestation of NHL?

Painless lymph node enlargement.

Clinical manifestations of CLL?

Patient is usually asymptomatic and diagnosed on routine CBC. -Chronic fatigue -Anorexia -Splenomegaly -Lymphadenopathy -Hepatomegaly -Fever -Night sweats -Weight loss -Frequent infections -Pulmonary Sx secondary to mediastinum node involvement -Numbness and tingling from swollen lymph nodes exerting pressure

What tests are done to diagnose Hodgkin's Lymphoma?

Peripheral blood analysis Lymph node biopsy Bone marrow examination Radiologic evaluation Diagnostic studies (used to determine disease stage)

___________ are produced in the bone marrow and are essential to blood clotting. Responsible for maintaining vascular integrity. Life span 7-9 days.

Platelets.

Normal values for RBC and WBCs?

RBCs male 4.5-5, female 4-5 WBCs 5,000 - 10,000

Define intensification therapy.

Same drugs as induction therapy, higher doses.

What is one risk of being treated for Hodgkin's Lymphoma?

Secondary cancer 15 years in future.

How is the staging done for NHL?

Similar to Hodgkin's Lymphoma - looking at how many nodes are involved and relationship to diaphragm.

Nursing care for NHL?

Similar to Hodgkin's Lymphoma. Nursing care is based on managing problems related to disease (e.g. pain).

Is watchful waiting appropriate for leukemia?

Sometimes it is.

Stages 1-4 for Hodgkin's Lymphoma - what are they?

Stage 1 - single lymph node, single site Stage 2 - 2 or more lymph nodes on site of diaphragm Stage 3 - Either side of diaphragm Stage 4 - Diffuse organ involvement

Chronic Myelogenous Leukemia - what is the "hallmark sign" of this type of leukemia?

The Philadelphia Chromosome, present in 90% of cases.

What do neutrophils do?

They fight off infection. They are the body's first line of defense. They go to the site of infection and cause phagocytosis of particles such as bacteria.

What is the goal of thrombocytopenia precautions?

To prevent serious bleeding.

Clinical manifestations of Hodgkin's Lymphoma?

Weight loss Fatigue Weakness Fever Chills Tachycardia Night sweats

When does the neutrophil count increase?

When there is an infection. They are part of the immune defense system.

Why is non-Hodgkin's Lymphoma "worse" than Hodgkin's Lymphoma?

Widely disseminated disease is usually present at time of diagnosis.

Which types of leukemia are more common in men, and which in women?

They are all more common in men.

What are the 4 major classifications of leukemia?

Acute Myelogenous Leukemia (AML) Acute Lymphocytic Leukemia (ALL) Chronic Myelogenous Leukemia (CML) Chronic Lymphocytic Leukemia (CLL)

What are "allogenic", "syngenic" and "autologous"?

Allogenic - volunteer donor Syngenic - identical twin Autologous - from self

What are the symptoms of lymphoma?

Enlarged lymph nodes, weight loss, fever, night sweats, and pruritus.

What does a hematopoietic stem cell transplant actually do?

Eradicates the patient's hematopoietic stem cells which are replaced with those of an HLA-matched donor.

Clinical manifestations of CML?

Fatigue, weakness (not severe) Fever Sternal tenderness (because of lymph node involvement) Weight loss Joint pain Bone pain Massive splenomegaly (painful) Increased sweating (night sweats)

What are anemia, thrombocytopenia, and neutropenia?

A problem with the RBCs, platelets, or WBCs, in that order.

What is a lymphocyte?

A small leukocyte (WBC).

What is a leukocyte?

A white blood cell, produced in the bone marrow, found in the blood and lymphatic system.

Clinical manifestations of ALL?

Fever Pallor Bleeding Anorexia Fatigue Weakness Joint and bone pain Abdominal pain Lymphadenopathy Infection Weight loss Headache Mouth sores Increased intracranial pressure Seizures

How is non-Hodgkin's Lymphoma classified?

According to different cellular characteristics and lymph node characteristics.

What is the most reliable and sometimes the only sign of neutropenia?

Fever of 100.5 (38 C).

What is neutropenia? What is the major problem with it?

A decreased number of neutrophils that occurs when bone marrow production cannot keep up with the demand. The patient's immune system is compromised and is at increased risk for infection.

Define leukemia.

A general term used to describe a group of malignant disorders of the blood, blood-forming tissues of bone marrow, lymph system, and spleen. It involves the uncontrolled proliferation of non-functioning white blood cells.

Define induction therapy.

An attempt to bring about remission with aggressive chemotherapy.

Define leukocytosis.

An increase in the number of leukocytes, both normal and abnormal.

What is pancytopenia?

Anemia, thrombocytopenia, and neutropenia (all together).

What is the main goal of collaborative care for leukemia?

Attaining remission.

In severe neutropenia the client may NOT show "typical" signs of infection. Why?

Because the body is not producing enough WBCs.

What is a normal platelet count?

Between 140,000 and 400,000.

If there is mediastinal involvement in Hodgkin's Lymphoma, what type of problems might the patient have?

Breathing problems.

Classification: Myeloblasts - where does the cancer change take place?

Cancer change takes place in bone marrow that forms RBC, WBC, and PLT. Can cause anemia, thrombocytopenia, and neutropenia.

In what type of lymph node are 2/3 of people who get Hodgkin's Lymphoma first affected?

Cervical lymph nodes.

What is the treatment for NHL?

Chemotherapy (combination therapy) Radiation

What type of chemotherapy is used for leukemia?

Combination chemo.

What is the MAINSTAY of treatment for leukemia?

Combination chemotherapy.

What is meant by saying that Hodgkin's Lymphoma has a bi-modal age-specific incidence?

Common in males 15-35 years of age, and males >50 years of age.

What is the main diagnostic feature in Hodgkin's Lymphoma?

The presence of Reed-Sternberg cells in lymph node biopsy specimens.

In Hodgkin's Lymphoma, the initial symptoms that correlate with a worse prognosis are called______ __________? What are they?

The symptoms that correlate with a worse prognosis are called Beta symptoms and they are: Fever Night sweats Weight loss People who initially present with those symptoms have a worse prognosis.