NURS 443 Study Guide - Summer 2018, Comprehensive Midterm Notes - Syndrome, Fever, Tobacco Smoking
NURS 443
MIDTERM EXAM
STUDY GUIDE
Fall 2018
RNSG 2573: Concept: Cellular Regulation
Leukemia: group of malignant disorder affecting the blood and blood-forming tissues of the bone marrow, lymph system and spleen.
Lymphoma: malignant neoplasm originating in the bone marrow and lymphatic structures with proliferation of lymphocytes. 5th most common type of cancer in US
ALL
Acute lymphocytic
AML
Acute Myelogenous
CML
Chronic
myelogenous
CLL
Chronic lymphocytic
Hodgkin’s
Non-Hodgkin’s
Age of onset
Children: median age: 13
Most common leukemia
in children
Increases with age after
60
*Immature cells*
Most common
cancer in children 0-7
yrs
Increase with age
after 55
25% of all leukeia’s:
80% of adult acute
leukeia’s
Increase with age
after 55
Increase with age
after 50, greater in
men
Most common
leukemia in adults
*Mature cells,
abnormal*
15-35 and above 50
Men>women in
adults
Good long term
survival
Affecting all ages
5th leading cause of cancer
death
Assessment
See table 21-27 for data
Fever, lymphadenopathy, lethargy, pallor, purpura (easy bruising), tachycardia, murmurs, gingival
bleeding/hyperplasia, oral ulcers, hepatomegaly, sz, HA, disorientation decreased coordination,
bone or joint pain
B symptoms
correlate with a
worse prognosis:
initial findings of
fever (>100.4), night
sweats, and greater
than 10% wt loss in 6
months
Risk factors
Exposure to toxins, radiation, viruses, chromosome abnormalities leukeia: Dow’s sydroe,
immune deficiencies, organ transplants, prior cancer, family history
Some viruses, bacteria,
chemicals, inherited
immunodeficiency syndromes
and immunosuppressive
drugs.
Clinical manifestation
*leukeia’s: r/t bone
marrow failure and
formation of leukemic
infiltrates
Fever, pallor, bleeding,
anorexia,
fatigue/weakness. Bone,
joint, and abd pain.
General
lymphadenopathy,
infections, wt loss,
Fatigue/weakness,
HA, mouth sores,
anemia, bleeding,
fever, infection,
sternal tenderness,
gingival hyperplasia,
mild
No symptoms early in
disease. Fatigue and
weakness, fever,
sternal tenderness,
wt lost, joint pain,
bone pain, massive
splenomegaly,
Freq no symptoms.
Found during exam
for unrelated
condition. Chronic
fatigue, anorexia,
splenomegaly and
lymphadenopathy,
Enlarged cervical,
axillary, or inguinal
lymph nodes. Wt
loss, fatigue,
weakness, fever,
chills, tachycardia, or
night sweats.
May orginate outside lymph
nodes. Primary finding is
pailessl ymph node
enlargement that comes and
goes. . other symptoms based
on how wide spread:
hepatomegaly, CNS symtoms.
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hepatosplenomegaly, HA,
mouth sores, IICP, CNS
symptoms
hepatosplenomegaly
increase sweating
hepatomegaly. May
progress to fever
with night sweats, wt
loss, fatigue, and freq
infections
Cough, dyspnea,
stridor, dysphagia
may be present with
mediastinal node
mass. Other s/s
depending of site of
nodes.
B sytos see Hodgki’s
Diagnostic tests
Low RBC, H/H
WBC: low, nor, or high
High LDH
Bone changes on x-ray,
Lymphoblasts in bone
marrow and possibly CSF
Low RBC, H/H,
platelet.
WBC: high to low
with myeloblasts
High LDH
Hypercellular bone
marrow with
myeloblasts
Low RBC, H/H, High
platelets early-then
lower later, increase
neutrophils
+Philadelphia
chromosome in 90%
of patients
Mild anemia &
thrombocytopenia
with progression.
WBC >100,000
Hypogammaglobulin
emia. May have
autoimmune
hemolytic anemia,
idiopathic
thrombocytopenic
purpura
Abnor. CBC: may be
r/t treatment.
Hypoferremia,
hyperclcemia,
hypoalbuminemia.
PET and CT scan to
identify masses
See Hodgki’s
Additionally: MRI, barium
enema, lymph node biopsy for
cell type and pattern.
Clinical management-
Goal for all: attaining
remission
Lewis 9e: table 31-26
(drugs)
Chemo: combination
Cranial radiation,
Intrathecal chemo,
allogeneic Stem cell
transplant (HSCT)
Chemo: combination
Autologous or
allogeneic Stem cell
transplant
Chemo: combination
Radiation, HSCT,
interferon
Chemo: combination
Radiation,
splenectomy,
allogeneic Stem cell
transplant,
Colony-stimulating
factors
Based on staging:
Chemo/multi drug
Radiation as a
supplement
HSCT
See table 31-30. Is it indolent
or aggressive?
Nursing interventions
Review all drugs: side effects, safe handling, toxic effects. Assess lab. Emotional support/may be
away from family. ma
r/t problems to the
disease, pain
management, side
effects of rx., etc,
Manage problems r/t disease
Possible radiation burns
Teaching
Acute side effects of treatment are usually temporary.
What the side effects are.
find more resources at oneclass.com
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Document Summary
Increase with age after 50, greater in men. Fever, lymphadenopathy, lethargy, pallor, purpura (easy bruising), tachycardia, murmurs, gingival bleeding/hyperplasia, oral ulcers, hepatomegaly, sz, ha, disorientation decreased coordination, bone or joint pain. Exposure to toxins, radiation, viruses, chromosome abnormalities (cid:894)leuke(cid:373)ia: dow(cid:374)"s sy(cid:374)dro(cid:373)e(cid:895), immune deficiencies, organ transplants, prior cancer, family history. B symptoms correlate with a worse prognosis: initial findings of fever (>100. 4), night sweats, and greater than 10% wt loss in 6 months. Leukemia: group of malignant disorder affecting the blood and blood-forming tissues of the bone marrow, lymph system and spleen. Lymphoma: malignant neoplasm originating in the bone marrow and lymphatic structures with proliferation of lymphocytes. 5th most common type of cancer in us. *leuke(cid:373)ia"s: r/t bone marrow failure and formation of leukemic infiltrates. Ha, mouth sores, anemia, bleeding, fever, infection, sternal tenderness, gingival hyperplasia, mild. Fatigue and weakness, fever, sternal tenderness, wt lost, joint pain, bone pain, massive splenomegaly, Wt loss, fatigue, weakness, fever, chills, tachycardia, or night sweats.
