W1: HEMATOLOGICAL PROBLEMS
High levels of Hgb (4)
#1 Dehydration/ INCREASE HCT (1:3) 2. Lung Disease- COPD, Emphysema, Smokers, Cancers 3, Polycythemia Vera (PV) High altitudes- HIGHER HgB#
What is the cause of ITP?
CX: (VIRAL) H. pylori/ Viral infections cause (CHILDHOOD)
What is the TX for Aplastic Anemia? 2
(TX- BONE MARROW) 1.HSCT and 2. immunosuppressive therapy with ATG and cyclosporine ([P.O. CYTOXAN)
Foods for Folic Acid?
*Green leafy vegetable, liver, meat , fish, legumes and whole grain, * oragnace juice *, nuts
UNIQUE FINDING WITH HL?
PAIN AFTER ETOH
PREMEDICATE BEFORE BLOOD TRANS????? (1)
PREMEDICATE W BENADRYL 30 min before
What to teach to the patient before?
sweatinging, chills, Chest pain, itching, SOB, Headache, Back pain, N&V= STOP
What is the TX plan for Leukemia? TUMOR LYSIS SYNDROME RISKS (AML, ALL, CML)
1. Dexamethasone + Ondansetron (nausea/ vomit pre chemo) 2. Daily Labs: CBC with diff, Serum Electrolytes, Serum Bilii, Alk Phophate, Ast, Alt 3. Hydration (CISPLATIN) 4. MONITOR S/S OF TUMOR LYSIS SYNDORME (3) 5. Allopurinol - uric acid 6. Bone marrow bx- progress
Laboratory manifestations= polycythemia vera: (4)
ELEVATED 1. CBC: RBC/ H&H 2. Bone marrow examination = hypercellularity 3. LIVER Functions: elevated leukocyte alkaline phosphatase, uric acid and vitamin B12 levels 4. KIDNEY FUNCTION- (2)LOW low to normal EPO level
Medications to stimulate bone marrow- Stimulation Erythropoiesis- increase Hgb, HCT))
Epoetin (Epogen, Procrit, Erythropoietin) Darbepoetin CONTA BREAST CANCER/ THROBOEMOLISMS
S/S OF HYPERCALCEMIA RISK.
Nausea and vomiting, loss of appetite Abdominal pain, constipation Polyuria, polydipsia Muscle weakness CNS: Fatigue, depressed, apathy, Irritability Bone pain
What is the definition of Multiple Myeloma?
Overproduction of PLASMA CELLS from B cells = IMMUNOGLOBULINS- ATTACK SKELETAL; Break down BONE! (B cell) Malignant tumor of the SKELETON
NEEDLE SIZE/ COLOR Blood Administration (3) BEST
PINK 20G * (fluids, blood)*** GREEN 18G (Emergency, Trauma high risks of surgeries etc.); GRAY 16G = 22g= BLUE- VESICANT/ CVA 24 g yellow
TX: multiole myleoma
1. Chemo and radiation 2. Target therapries (-nib, mib, -mabs) 3. Allopurinol/ IVF 4. Biphosphonates (-dronates)
acute leukemia, the abnormal cells can accumulate in the brain or spinal cord
(SPINAL TAP! DX)S/E = Headaches, vomiting, confusion, seizures.
AML= acute myelogenous leukemia DX TESTS
1. Low H&H 2. Low WBC 3. Low PLT *high LDH bone marrow- Myelobalasts
What are the lab results for Thrombocytopenia? (2)
1. CBC- ↓ hemoglobin and hematocrit; PLATELET CT. (LOW) < 150, 000 - Thrombocytopenia= 10k= Platelet transfusions 2. PT, PTT (PROLONGED BLEEDING TIME) -Prolonged bleeding- trauma/ injury
major complication of PV?
- The most common serious acute complication is STOKE secondary to thrombosis.
1. HEMOLYTIC REACTION S/S
- immune system is killing the donor RBC; Antibodies don't match... =ABO INCOMPATIBILITY/ MISTYPED! (mistake) S/S: Fever, chills, Anxiety, back pain, chest pain, Back pain, increase HR (Tachycardia), Low BP, Hemoglobinuria
2. ALLERGIC reactionS/S
- immune system with protein on donor S/S: RASHES, HIVES, itching, anaphylaxis! Wheezing, Swelling
chronic myelogenous (granulocytic) leukemia (CML),
- mature neoplastic granulocytes (HIGH NEUTROPHILS) in the bone marrow.= HEPATOSPLEENOMEGALY
What are the Pre admin supplies? (3)
-IV ACCESS- 18G OR LARGER! (COLOR?- PINK) -Y TUBING! (incase of other IV drugs!) with IN LINE FILTER! -N.S. .9% (no dextrose- can cause clumping)
A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best? a. It inhibits thrombin. b. It inhibits fibrinogen .c. It thins your blood. d. It works against vitamin K
.ANS: ARivaroxaban is a direct thrombin inhibitor. It does not work on fibrinogen or vitamin K. It is not a blood thinner, although many clients call anticoagulants by this name.
DX labs of Aplastic anemia/ PANCYTOPENIA? (3)
1. (*DECREASE) RBC (erythropenia) - ANEMIA (low RBC/ H&H) 2. WBC (Leukopenia/ Neutropenia) 3. PLT : Thrombocytopenia= BLEEDING (e.g., petechiae, ecchymosis,
What are examples for nutrition- Iron?7
1. **DARK LEAFY GREENS, veggies , 2. LIVER (HIGHGHEST) , MUSCLE MEATS, 3. EGG YOLKS 4. LEGUMES, peas, beans 5. Whole grain breads, cereals, 6. , RAISINS 7. FISH, poultry
What are the Clinical manifestations of ALL? (2) +
1. , LYMPHDENOPATHY, 2. Fever, infections and Weakness, fatigue 3. night sweats 4. Bleeding , brusing, petchia , 5. Central nervous system (CNS) manifestations (SPINAL TAP)- (ICP S/S)
Normocytic, normochromic (normal size and color) MCV 80-100 fL ?? (5)
1. Aplastic anemia*, 2. Sickle cell anemia, pregnancy 3. Acute blood loss*, 4. hemolysis, 5. Anemia of chronic disease= Chronic Renal Disease (EPO),
S/S MULTIPLE MYELOMA (6)
1. BONE PAIN/ FX 2. Hypercalcemia 3. Renal disease 4. Infections 5. Hyperviscosity Syndorme 6. Neurological abnomaltiies- spinal
dx for multiple myeloma (5)
1. BONE biopsy - B CELLS (BONE) 2. CBC- PANCYTOPENIA 3. Blood- spectrum analysis- spikes- Igb- G/M- PROTEIN 4. Bence Jones protein in the urine. 5. CMP= HYPERCALCEMIA /
Diagnostics OF HL?(3)
1. Biopsy of Lymph Nodes/ 2. Bone bx= REED STEINBURG CELLS 2. CT
What are the DX tests for Aplastic Anemia? (4
1. Bone Marrow- DECREASED-hypocellular (Frequent or severe infections enlarged Lymph nodes ); 3. CBC (LOW) reticulocyte count is low. 3. Bleeding time is prolonged. 4. serum iron and total iron-binding capacity (TIBC) may be elevated as initial signs of erythropoiesis suppression.
What are the TEST/ PROCEDURES: PRE TREATMENT (5)
1. Bone marrow Biopsy for staging 2. Labs: CBC with Diff, HLA typing, Creatinine, Uric Acid, Mg, Bilirubin, SGPT(ALT), SGOT (AST), and Alk Phos 3. ECG- arrhythmias / LVEF > 45 by Echo or Muga 4. Baseline Ht, WT and PE= BSA 5. Quality of Life assessment completed/ Geriatric Assessment
What are diagnostic tests? TTP (2)
1. CBC 2. Bone marrow biopsy OTHERS: **Peripheral blood smears (ITP, TTP) ITP antigen-speci"c assay, 1 LDH (TTP- ADAMTS13 )- TTP guaiac-positive stools
What are the DX tests for Anemia? 4
1. CBC (RBC, H&H) = CBC: ↓ RBCs, ↓ Hgb; ↓ Hct; or ↓ reticulocytes, MCV, 2. SERUM IRON, COBALAMIN (B12) , FOLIC ACID =(LOW) 3. Bone Marrow 4. TIBC -Total iron-binding capacity EPO=↓ serum erythropoietin level
What are the dx tests for Leukemia? - (3)
1. CBC with diff 2. Bone marrow bx 3. Spinal tap (CNS)
What are other causes of pernicious Anemia? (5)
1. GI surgery (Ileum/ damage to parietal cells- B12/ IF) 2. Nutritional Deficit Vit. B12- strict vegetarians (NO RED MEATS- LIVER);( no Meat, fish, dairy, eggs)/ 3. Older adults- Gastric Acidity 4. MEDS: long-term users of H2-histamine receptor blockers (Ranitidine- ulcers/ GERD) and proton pump inhibitors (omeprazole/ ASPIRIN- GASTRITIS) 5. Endocrine dx; GI disease; Crohn's disease, ileitis, celiac disease,diverticula Chronic alcoholism
What are the dx tests for Iron deficient Anemia? 5
1. Low HCT and HgB (RBC measures) 2. Low Serum Ferritin Level/ Low serum Iron Level 3. High* iron binding capacity (TIBC) in the blood 4. Small* RBC under microscope -Microcytic 5. Blood in the stool (GI bleed)
HL Clinical Manifestation?
1. Lymphadenopathy- neck, chest, axillary/ inguina- painless/ nontender 2. mediastinal node mass (chest) 3. Pruitis 4. Anemia 5. Hepatospleenomegaly/ juandice
Symptoms Hodgkin's Lymphoma: B symptoms (5)
1. Lymphadenopathy: neck- Mediastinal (chest), axillary, inguinal, retroperitoneal nodes (CT) 2. Night sweats 3. Low grade fevers (in excess of 100.4°F [38°C]) 4. Tachycardia 5. Weight loss
WHAT ARE THE INR/ COUMADIN VALUES TO KNOW- WHY (3)? RATIONALE?????
1. Normal Values: 0.8 - 1.20 (NOT ON COUMADIN*) 2. Therapeutic: 2 - 3 (ON COUMADIN*) 3. High Intensity: 2.5 - 3.5 (Head mechanical Heart valve*- blood touch metal- coagulation- clotting; ??? D/C COUMADIN DAYS BEFORE ELECTIVE SURGERY (AF)- REPLACE LOVENOX)
WHAT ARE THE PTT VALUES (2) RATIONALES WHAT IS THE ANECDOTE?
1. Normal value: 26 - 36 (no on Heparin IV Therapy)*** 2. Therapeutic value: 60-80 (On (Heparin Drip IV therapy)) PROTAMINE HEPARIN
TX FOR PV?2
1. Phlebotomy - 500 ml blood removed)/ 2-3 months. HgB <18; Decrease HCT (45-48%) everyday 2 Avoid iron supplements- NO BLOOD TRANS > 300 mg Iron 2. CHEMOTHERAPY = CYTOXAN (p.o)
Clinical Manifestations: PV?
1. RBC: Risk of - Hypervolemia/ Hepatospleenomegetly 2. inflamations- PRUITUS- showers 3. CARDIO: angina, HF, intermittent claudication, and thrombophlebitis, which may be complicated by embolization. 4. Paresthesias and erythromelalgia, AMS, headaches
What are Diagnostic tests with Pernicious Anemia? (6)
1. Serum Vitamin B12 level/ Intrinsic Factor 2. CBC (low HCT with elevated MCV*) - 3. Bone marrow Examination-Bone marrow Aspirations/ B RISK FOR gastric cancer 4. Schilling test ***(to determine where the deficiency in B12 deficiency lies) 5. Elevated LDH 6. Peripheral Blood smear (MEGALOBLASTIC)
What are the Common Signs/Symptoms of Leukemia?(5)
1. Swollen or tender lymph nodes, liver or spleen 2. Fever, chills, Night sweats + weakness and fatigue, 3. Bleeding or bruising Swollen or bleeding gums 4. Bone / joint pain. 5. CNS (ALL)- manifestations- SPINAL TAP- s/s headache, vommiting, confusion, seziures
INTRA ADMIN
1. VS taken before and 15 mins after; remain with patient with first 50 ml infusion (reactions); Monitor every 30 mins; Q1 hour after transfusion If patient is Febrile (Fever)- Call HCP
What are the pre admin procedures?
1. consent, allergies, # of past trans 2. TYPE AND CROSSMATCH (ABO COMPATIBILITY)*- Blood bank 3. PREMEDICATE W BENADRYL 30 min before
What is the TX: ITP (4)
1. intravenous immunoglobulin (IV IG) 2. Plasmapheresis 3. Spleenectomy 4. Immuosupressives (Cytoxan)
What are Clinical Manifestations of NHL? HLs can originate outside the lymph nodes 4
1. lymphadenopathy- painless lymph node enlargement= indolent disease. 2. HEPATOMEGALY with liver involvement 3. NEUROLOGIC symptoms with CNS disease 4. HYPERURMIA and renal failure= TLS
ACQUIRED HEMOLYTIC ANEMIA (4)
1.Macroangiopathic: physical trauma (prosthetic heart valves, extracorporeal circulation) 2. Microangiopathic: disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenic purpura (TTP) = CHEMOTHERAPY* 3.Antibodies (isoimmune and autoimmune) 4. Infectious agents (e.g., malaria) and toxins
TX: TTP (CHEMO) 5
1.Plasmapheresis (plasma exchange) • 2. Immunosuppressives (- CYTOXAN, rituximab [Rituxan]) 3. Splenectomy 4. Chemotherapy (vincristine [Oncovin], vinblastine [Velban]) 5. High-dose prednisone (CORTICOSTEROIDS)
BLOOD TRANSFUSION RULES
2 RN CHECK (order, ABO, patient) Give Blood 30 mins (on floor- send back!); BLOOD INFUSE WITHIN 4 HRS Febrile- notify physician; NO BLOOD TRANS- > 300 MG IRON LEVELS
What is the Universal Recipient? Universal Donor?
AB + (RECIPIENT- ANYONE!) O - (ANY- .... Only receive from O- )
he nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? a. Neutropenia b. Increasing fatigue c. Thrombocytopenia d. Frequent constipation
ANS: A The low white blood cell count indicates that the patient is at high risk for infection and needs immediate actions to diagnose and treat the cause of the leucopenia.
The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client? a. Clopidogrel (Plavix) b. Enoxaparin (Lovenox) c. Reteplase (Retavase) d. Warfarin (Coumadin)
ANS: AClopidogrel is a platelet inhibitor. Enoxaparin is an indirect thrombin inhibitor. Reteplase is a fibrinolytic agent. Warfarin is a vitamin K antagonist.
The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication? a. Aspirin b. Heparin c. Warfarin d. Erythropoietin
ANS: B Activated partial thromboplastin time (aPTT) assesses intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. aPTT is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec).
A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about a. blood transfusion b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.
ANS: B Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.
IMAGE A patients complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a. Have you had a recent weight loss? b. Do you have any history of lung disease? c. Have you noticed any dark or bloody stools? d. What is your dietary intake of meats and protein?
ANS: B The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease (COPD).
A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/L while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patients home.
ANS: B The patient may be taught to self-administer filgrastim injections. A
A nurse is caring for four clients. After reviewing todays laboratory results, which client should the nurse see first? a. Client with an international normalized ratio of 2.8 b. Client with a platelet count of 128,000/mm3 c. Client with a prothrombin time (PT) of 28 secondsd. Client with a red blood cell count of 5.1 million/L
ANS: C A normal PT is 11 to 12.5 seconds. This client is at high risk of bleeding. The other values are within normal limits.
The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? a. Yellow-tinged sclerae b. Shiny, smooth tongue c. Numbness of the extremities d. Gum bleeding and tenderness
ANS: C Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.
A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl).
ANS: C The patients clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered.
0. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count
ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients
A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.
ANS: D Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration.
15. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time
ANS: D Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.
Decreased number of erythrocyte precursors:
Aplastic anemia, Myelodysplasia Syndrome
ITP PATHO:
Autoimmune disease- IgG antibody that targets platelet glycoproteins- destruction of the platelets Antibody-coated platelets are sequestered (HIDEN) and removed from the circulation- SPLENOMEGALY
Location of HL?
Begins in the upper body: neck, chest (mediastinal) or armpits (axillary).- = lungs, spleen and liver
What is the patho of MM?(3)
Chromosomal translocations and protoncogene M PROTEIN Bence Jones proteins
Macrocytic (megaloblastic), normochromic (large size, normal color) MCV >100 fL, MCH >
Cobalamin (vitamin B12) deficiency*, Folic acid deficiency*
Decrease HgB Synthesis: Decrease DNA synthesis:
Decrease HgB Synthesis: IRON deficiency Decrease DNA synthesis: Vitamin B12 + Folic Acid
Circulatory Overload (Pulmonary problem, sit up); PREVENT WITH SLOW INFUSION AND LASIX
Dyspnea Orthopnea Productive Cough Tachycardia Elevated blood pressure Headache left ventricle pulmonary edema
What is the first sign of HIT?
Fall in platelet count = initiation of heparin-develop thrombocytopenia 5 or 10 days after the - 50% PLT NOOOOOOOO Symptoms of bleeding are unusual because the platelet count rarely drops below 60,000/μL.
CLL DX LABS
HIGH WBC > 100,00 increase Lymphocytes ITP Hemolytic Anemia
What are the Classifications of Leukemia?
I. acute lymphocytic leukemia (ALL)- (0- 14)= CHILDREN** CANCER- Most common II. acute myelogenous leukemia (AML), (40-60)= OLD AGE I. chronic myelogenous (granulocytic) leukemia (CML), chronic lymphocytic leukemia (CLL).> 60 Y,O.- OLD ADULT
What are the Clinical Manifestations of Anemia? (Integement, Eyes, GI, Cardio, Respir, CNS, Organs (2), Severe, Others )
Integument: Pallor, Jaundice, Prutis (Increase bilirubin) GI: Glossitis- BEEFY RED SMOOTH TONGUE- sore, dysphagia, Weight loss Retinal Hemorrhage- Blurred Vision; inceteric (yellow SCLERA)*, conjunctiva and sclera Cardio: Tachycardia, Systolic murmurs/ increase SV (compensatory) Respir: SOB, Dyspnea, Tachypnea- Palpitations CNS: FATIGUE, headache, Lethargic, weakness, irritability = COLD SENSITIVITY Hepatosplenomegaly Others: HF S/S (severe) intermittent claudication (Severe) angina, Heart failure, MI, cardiomegaly, Acited, peripheral edema Roaring in the ears
Increased Erythrocyte destruction:
Intrinsic: the abnormal Hemoglobins, enzyme deficiency Extrinsic- Physical Trauma from heart valves and antibody destruction
Microcytic, hypochromic (small size, pale color) MCV <80 fL, MCH <27 pg
Iron-deficiency anemia, **Hold Blood transfusion- Iron level > 300 mg
CAUSE OF AI PERNIOUS ANEMIA?
LACK OF INTRINSIC FACTOR- FOR B 12 absorption (Ileum)/ HCL - this is an autoimmune cause- Pernicious anemia = effects Nervous system* (B12) + Cardiac System
CLL (chronic lymphocytic leukemia)-CLL is the most common leukemia in adults.
LYMPHDENOPATHY WHOLE BODY Pressure on nerves from enlarged lymph nodes causes pain and even paralysis. Mediastinal node enlargement leads to pulmonary symptoms.
Low levels of Hgb Causes? -*IMPAIRED GAS EXCHANGE*
Loss of Blood Kidney failure Nutritional deficiency Bone Marrow Problems
Chronic Lymphocytic Leukemia. CLL is the most common leukemia in adults.
Lymphocytes. B cells are = LYMPHDENOPATHY.
Vitamin B6: 6
Meats liver, legumes pork, wheat germ, , potatoes bananas, corn meals
What are the clinical manifestations of Pernicious Anemia?
NERVOUS SYSTEM: PARESTHESIA (burning/ tingling)-NUMBNESS- hands and feet- 2. MUSCLE WEAKNESS, ataxia 3. Memory; Confusion; depression- confusion to dementia.*NEUROLOGICAL PROBLEMS*(imapired thought process) - B 12= MEMORY
What are the causes of NHL?
NHLs may result from chromosomal translocations, Viruses (Epstein Virus)
HALL MARK- CML?
Philadelphia chromosome, - hallmark of CML
What are the symptoms of AML? (FLU LIKE) (4)
RBC: Shortness of breath,Pale skin, Lethargy and fatigue WBC: Fever, Frequent infections PLT: Easy bruising, epistasis, gingival bleeding Bone pain
3. FEBRILE -
Recipient's WBC reacting with donors WBC- Antibodies S/S: Increase temperature (1- 2 F) (MOST COMMON- body creates antibodies- ask pt. Hx of transfusions)
What are examples of Nutrition- VITAMIN B12 ? 5
Red meats, LIVER (memory*), Eggs, grains, Fish DAIRY, Milk,
What is the main Dx/ finding with HL? What are risk factors for HL?
Reed-Sternberg cells in lymph node biopsy infection with EpsteinBarr virus (EBV),
CHEMO FOR NHL= R-CHOP
Rituximab Cyclophosphominde (Cytoxan) Doxorubicin Vincristin Prednisone
DRUG FOR NHL?
Rituximab, = MoAb hypersensittivity • Manifestations may include hypotension, bronchospasm, dysrhythmias, angioedema, and cardiogenic shock. • Screen - may reactivate Hepatitis.
NURSING ACTIONS- BLOOD TRANSFUSION REACTIONS
STOP TRANSFUSION, time; D/C TUBING- 0.9 % NS REPORT TO HCP/ blood bank Check Identifications Stay with patient / VS Q 5 mins Send Blood bag/ tubing to blood bank (DON'T THROW AWAY) Collect- labs/ blood/ UA- evidence of reaction cause =The blood bank and laboratory are responsible for identifying the type of reaction. (not rn) Meds- Corticosteroids, Antihistamines, Antipyretics, Fluids, Vasopressors/ Dilators (Circulatory)
Treatment of Circulatory Overload
STOP transfusion Oxygen therapy Diuretics Bronchodilators Vasodilators (decrease BP)
What is the rate for the Trans?
Start 2 ML/ MIN for first 15 mins - MONITOR S/S; VS Q15, 30, 1 HR
What is the TX of HIT?
TX: D/C heparin; Alternative Direct thrombin inhibitor- Lepirudin or argatroban no platelet trans
Coumadin ANECDOTE? -
Vitamin K- TOO MUCH coumadin- Reversal)
HL Chemo regimen - ABVD regimen:
doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine.
Acute Lymphocytic Leukemia. ALL is the most common* type of leukemia in CHILDREN(0-14) PATHO
immature small lymphocytes= B-cell origin. - LYMPHDENOPATHY*
4. GVHD- rare/ deadly-
occurs days/ weeks after trans; Donors T lymphocytes cause a response in the recipient by engrafting in the marrow and attacks recipients tissues S/S: Fever, RASH ALL OVER THE BODY (FEET AND HANDS), GI issues, diarrhea, nausea, Liver inflammation
What is the definition of NHL?
primarily B-, T-, or natural killer (NK) cells; B-cell lymphomas con- stitute about 85% of all NHL involve many peripheral nodes and extendodal tissues-Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body,
PT/ INR?
warfarin (Coumadin). Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of Aspirin affects platelet function.