Summary Nur 145 Leukemia Study Guide Practice

NUR 145 STUDY
GUIDE PRACTICE
CHEAT SHEET

, NUR 145
Diagnosis

 Physical Exam
 Bone marrow aspiration
LEUKEMIA  Radiograph of long bones reveals lesions
o X-ray, CT scan, and Ultrasound
 Distorted and uncontrolled proliferation of  Lumbar puncture
WBCs
Therapeutic Management
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
Up to 95% will have a first remission but if a child
 Develops from lymphoblasts or immature WBC experiences a relapse, chances of long-term survival are
 With rapid proliferation of lymphoblasts, RBC and reduced to 70%
platelet production fall and invasion of body organs
by the WBCs begins  Chemotherapy (Intrathecal)
 Common in children between 2-6 years old o Induction phase – kill all the leukemia
 Idiopathic (Unknown cause) cells in the bone marrow
 Common in male, white children, and children o Sanctuary phase – preventing leukemia
with Down Syndrome or Fanconi Syndrome cells from invading or growing in the
CNS
CHRONIC LYMPHOID LEUKEMIA (CLL) o Administer delayed intensive therapy
o Maintenance phase – maintaining the
 Same with ALL but CLL is slow-growing. original remission
 Common in adults, rare in children  Bone marrow transplant
 Nursing Interventions
o Maintain positive room pressure
Assessment o Methotrexate
Chemotherapy in Children
 1st Symptoms
o Pallor  Administration via central venous catheter or
o Low-grade fever port to prevent irritation of vessel walls
o Lethargy  Drugs (Given over 4 weeks)
o Petechiae o Vincristine, Prednisone, L-asparaginase,
o Bleeding Doxorubicin, and Methotrexate
o Bruise easily  Cell destruction due to chemotherapy results in
 As spleen & liver enlarge due to infiltration of
increased uric acid level which may destroy
abnormal cells, abdominal pain, vomiting,
glomeruli and leads to loss of kidney function
anorexia occurs
o Allopurinol – reduce UA production
 As abnormal lymphocytes invade bone
 Hydration helps UA excretion
periosteum, bone and joint point pain
 Intrathecal administration of drugs may be
 CNS invasion leads to headache, unsteady gait
included to bypass the blood-brain barrier
 Physical exam reveals painless, generalized
swelling of lymph nodes Maintenance and Monitoring
 WBC count is markedly elevated
 Combination of daily Mercaptopurine, weekly
 Platelet and hematocrit are low
Methotrexate, Sporadic Vincristine and
 RBCs are normochromic and normocytic
Prednisone, and Intrathecal Methotrexate and
Disease Classification & Prognosis may be continued for 2 to 3 years.
 Leucovorin (given after Methotrexate)
 Can affect lymphocytes o To protect normal cells
o T-lymphocytes cells – 85%  Blood values must be monitored monthly
o B-lymphocytes cells – 15-20%

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, Complications  Hypertension may occur
 Anemic (due to lack of erythropoietin formation)
 CNS involvement
o Blindness  Do not palpate child’s abdomen
o Hydrocephalus o Place a sign “No abdominal palpation”
o Recurrent seizures Diagnosis
o Nuchal rigidity
o Headache  CT scan reveals the tumor and points of
o Irritability metastasis
 Renal Involvement  GFR, BUN tests are done
o Kidney enlarges and function impaired o To assess the kidney before surgery
 Testicular Invasion
STAGE DESCRIPTION
o Leads to sterility
I Tumor confined to 1 kidney
(Unilateral) & completely removed
ACUTE MYELOID LEUKEMIA (AML) surgically
II Tumor extending beyond the kidney
 Involves the over proliferation of granulocytes but completely removed surgically
(Neutrophils, Basophils, and Eosinophils) III Regional spread of the disease
 Granulocytes grow so rapidly they are often beyond the kidney with residual
forced out into the bloodstream while still in the abdominal disease postoperatively
blast stage. It results in limited production of IV Metastases to lung, live, bone, distant
RBC and platelets lymph nodes, or other distant sites
V Bilateral disease (Both kidneys)
Assessment

 Same symptoms with ALL Treatment
 Susceptible to infection
 Nephrectomy
Diagnosis  Chemotherapy
 Radiation therapy
 Bone marrow aspiration & Biopsy
o To determine prognosis (M1 to M6)  Thoracotomy

Management Complications

 1-2 months of Cytarabine and Anthracycline  Nephritis
o To achieve full remission  Small bowel obstruction
 6-9 months of Cyclophosphamide and 6-  Hepatic damage
thioguanine  Sterility (girls) – radiation related damage
 Remission is difficult and brief to achieve  Interstitial pneumonia – radiation to the lungs
 Bone marrow transplantation is recommended
Prognosis: Highest survival rate among all childhood
cancer
WILM’S TUMOR/ NEPHROBLASTOMA
 Malignant cancer of the kidney
ASTHMA
Assessment  Narrowing of airway
 Discovered early in life (6 months to 5 years)  Occur in children with atopy or hypersensitive to
 Tumor felt as a firm, nontender abdominal allergens
mass  Triggers: pollens, molds, house dust, cigarette
 Manifest with hematuria and low-grade fever smoke, cold weather, cold weather, irritating
odor

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,  Aspirin can be trigger
 Mast cells release histamine and leukotrienes
 Cough suppressants are contraindicated
that result in diffuse obstructive and restrictive
 Inhaled anti-inflammatory corticosteroid such as
airway disease because of a triad of
Fluticasone daily
Inflammation, Bronchoconstriction, and
 Long-acting bronchodilator at bedtime
Increased mucus production
 For severe and persistent asthma, oral and
Cause inhaled corticosteroid daily
 Short-acting beta-2 antagonist bronchodilator
 Environmental and genetic factors
such as Albuterol or Terbutaline
Mechanism of the Disease o If attack begins
 Cromolyn sodium
 Bronchospasm – inflammation of bronchial
 Leukotriene receptor antagonists
mucosa and increased bronchial secretions all
 Encourage drinking of fluids during attacks
act to reduce the airway lumen, leading to
respiratory distress
 Bronchial constriction – due to stimulation of STATUS ASTHMATICUS
parasympathetic nervous system which initiates
smooth muscle constriction  Occurs when children fail to respond to
 Inflammation and mucus production - occurs medication during attack
because of mast cell activation to release  An extreme emergency because child may die of
leukotrienes, histamines, and prostaglandins heart failure
 Managed by oxygen therapy, continuing
Assessment nebulizer with beta-2 antagonist, IV
corticosteroid, and careful monitoring
 Dry cough (after exposure to an allergen)
 Difficulty in breathing
 Typical dyspnea and wheezing upon expiration URINARY TRACT INFECTION
 Mucus – white and has the shape of the bronchi
 Occurs more in females due to shorter urethra
 Cyanosis
 Caused by gram-negative rods (usually E. coli)
 Clubbing of fingers
 Tripod position - to ease breathing Symptoms

History  Pain on urination and frequency
 Burning
 Include history of the attack
 Hematuria
 Ask parents to describe home environment
 Low-grade fever
Physical assessment  Mild abdominal pain
 Enuresis
 Auscultate for wheezing
 Cyanosis & Eosinophilia may be present Urine culture is obtained by a clean-catch technique
 Pulmonary function studies
Management
 Antibiotic therapy
Therapeutic Management
 Increased fluid intake
3 goals:  Cranberry juice
 Avoidance of allergen  Repeat clean-catch sample after 72 hours of
antibiotic therapy
 Skin testing
 Hypo sensitization & relief of symptoms by
pharmacologic agents

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