NRSG 2350 Exam 2 with correct answers
Module 4
Disorders of WBC –
- know the clinical manifestations of variations in WBC levels and why patients present the way they do with initial
disease? What concerns you about alterations in the given WBC? What supportive care do you provide to patients
with cancer?
o Malignancy
▪ Patho: DNA damage that causes abnormal cell division w/o homeostatic restriction, anaplasia,
autonomy agenesis
▪ S/S: weight loss, fatigue, pain, bleeding
▪ Complications: anemia, alopecia, infection, mucositis, thrombocytopenia, malnutrition
▪ Supportive Care: chemotherapy, hormonal therapy, radiation, surgery, pain meds
o Lymphadenopathy
▪ Swelling of lymph nodes
o Lymphoma
▪ Hodgkin Lymphoma
● Common in Caucasians
● The presence of red Sternberg cells can start in any lymph nodes. Occurs mostly in neck,
chest, and upper arms
● S/S: swollen painless lymph nodes, weight loss, persistent fever, night sweats, coughing,
malaise, recurrent infections, pruritus (itchiness)
● Supportive care: same as non-Hodgkin
▪ Non-Hodgkin
● It is more difficult to treat that Hodgkin Lymphoma
● It involves multiple lymph nodes scattered throughout body metastasize in unorganized
manner
● Diagnoses: painless lymph node on neck, biopsy, CBC, chest X-rays
● Supportive care: chemo, radiation, immunotherapy, stem cell transplant
o Leukemia
▪ Malignant proliferation of WBCs in bone marrow or lymph tissue
▪ It is the most common childhood cancer- common in males
▪ S/S: lymph nodes and liver/spleen enlargement, petechiae (rash), pale conjunctiva, tachycardia,
ocular fundal hemorrhages
▪ Supportive Care: chemo, platelet and WBC transfusions, broad spectrum, antibiotics for infection
, o Multiple Myeloma
▪ Plasma cells proliferate, interferes with production of blood cells causing soft tissue masses
▪ Risk factors: black, males, occupational exposure to radiation, chronic inflammatory infection
(herpes)
▪ S/S: bone tenderness, pathologic fractures, spinal cord compression, epistaxis (nose bleeds),
thoracic deformities, hepatosplenomegaly (enlarged liver), retinal detachment, ecchymoses
(bruises)
▪ Complications: hypercalcemia, renal insufficiency, recurrent infections, spontaneous fractures,
hematologic imbalance
▪ Supportive care: Dialysis, bone marrow transplant, chemo, corticosteroids, surgery
o Abnormal functioning bone marrow
▪ Decreased RBCs (anemia)
▪ Decreased platelets (thrombocytopenia)
▪ Decreased leukocytes (leukocytopenia)
▪ All three components being decreased (pancytopenia)
▪ Production of bone marrow components may increase resulting in myeloproliferative disorders
(chronic myeloid leukemia, myelofibrosis, polycythemia vera, and essential thrombocytosis)
o Leukocytopenia
▪ Decreased # of leukocytes
▪ Caused by autoimmune diseases, medications (immunosuppressants, chemo, mental health meds),
sepsis, HIV/AIDS, radiation therapy
o Neutropenia
▪ Life threatening complication of chemotherapy (suppresses cell division or cell growth
▪ Patho: insufficient # of neutrophils (decreased WBCs)
▪ Causes: bone marrow suppression, chemo, antibiotics, viral illness, immune disorder
▪ Complications: sepsis (infection), death
▪ S/S: poor healing sores, bowel/bladder changes, voice changes, difficulty breathing
▪ Supportive care: Neupogen and filgrastim, monitor patient temp, restrict visitors that are sick, PPE
to protect patient, their own equipment, no fresh flowers/plants, no raw foods
o Leukocytosis
▪ Increase in the # of leukocytes in the blood; generally caused by infection
▪ Caused by infection, inflammation, leukemia, extreme stress, meds, side effects, etc
o Neutrophils
▪ Predominant form of granulocyte
▪ Makes up 60% of WBCs
▪ Surround and digest invading organisms and other foreign matter by phagocytosis
o Neupogen, medications (Injection)
▪ Stimulates production of neutrophils
▪ Uses: neutropenia and when bone marrow is suppressed and in patients with transplant
(subcutaneous and IV)
▪ Nursing interventions: monitor neutrophil levels and count, DO NOT ADMINISTER WITH
Module 4
Disorders of WBC –
- know the clinical manifestations of variations in WBC levels and why patients present the way they do with initial
disease? What concerns you about alterations in the given WBC? What supportive care do you provide to patients
with cancer?
o Malignancy
▪ Patho: DNA damage that causes abnormal cell division w/o homeostatic restriction, anaplasia,
autonomy agenesis
▪ S/S: weight loss, fatigue, pain, bleeding
▪ Complications: anemia, alopecia, infection, mucositis, thrombocytopenia, malnutrition
▪ Supportive Care: chemotherapy, hormonal therapy, radiation, surgery, pain meds
o Lymphadenopathy
▪ Swelling of lymph nodes
o Lymphoma
▪ Hodgkin Lymphoma
● Common in Caucasians
● The presence of red Sternberg cells can start in any lymph nodes. Occurs mostly in neck,
chest, and upper arms
● S/S: swollen painless lymph nodes, weight loss, persistent fever, night sweats, coughing,
malaise, recurrent infections, pruritus (itchiness)
● Supportive care: same as non-Hodgkin
▪ Non-Hodgkin
● It is more difficult to treat that Hodgkin Lymphoma
● It involves multiple lymph nodes scattered throughout body metastasize in unorganized
manner
● Diagnoses: painless lymph node on neck, biopsy, CBC, chest X-rays
● Supportive care: chemo, radiation, immunotherapy, stem cell transplant
o Leukemia
▪ Malignant proliferation of WBCs in bone marrow or lymph tissue
▪ It is the most common childhood cancer- common in males
▪ S/S: lymph nodes and liver/spleen enlargement, petechiae (rash), pale conjunctiva, tachycardia,
ocular fundal hemorrhages
▪ Supportive Care: chemo, platelet and WBC transfusions, broad spectrum, antibiotics for infection
, o Multiple Myeloma
▪ Plasma cells proliferate, interferes with production of blood cells causing soft tissue masses
▪ Risk factors: black, males, occupational exposure to radiation, chronic inflammatory infection
(herpes)
▪ S/S: bone tenderness, pathologic fractures, spinal cord compression, epistaxis (nose bleeds),
thoracic deformities, hepatosplenomegaly (enlarged liver), retinal detachment, ecchymoses
(bruises)
▪ Complications: hypercalcemia, renal insufficiency, recurrent infections, spontaneous fractures,
hematologic imbalance
▪ Supportive care: Dialysis, bone marrow transplant, chemo, corticosteroids, surgery
o Abnormal functioning bone marrow
▪ Decreased RBCs (anemia)
▪ Decreased platelets (thrombocytopenia)
▪ Decreased leukocytes (leukocytopenia)
▪ All three components being decreased (pancytopenia)
▪ Production of bone marrow components may increase resulting in myeloproliferative disorders
(chronic myeloid leukemia, myelofibrosis, polycythemia vera, and essential thrombocytosis)
o Leukocytopenia
▪ Decreased # of leukocytes
▪ Caused by autoimmune diseases, medications (immunosuppressants, chemo, mental health meds),
sepsis, HIV/AIDS, radiation therapy
o Neutropenia
▪ Life threatening complication of chemotherapy (suppresses cell division or cell growth
▪ Patho: insufficient # of neutrophils (decreased WBCs)
▪ Causes: bone marrow suppression, chemo, antibiotics, viral illness, immune disorder
▪ Complications: sepsis (infection), death
▪ S/S: poor healing sores, bowel/bladder changes, voice changes, difficulty breathing
▪ Supportive care: Neupogen and filgrastim, monitor patient temp, restrict visitors that are sick, PPE
to protect patient, their own equipment, no fresh flowers/plants, no raw foods
o Leukocytosis
▪ Increase in the # of leukocytes in the blood; generally caused by infection
▪ Caused by infection, inflammation, leukemia, extreme stress, meds, side effects, etc
o Neutrophils
▪ Predominant form of granulocyte
▪ Makes up 60% of WBCs
▪ Surround and digest invading organisms and other foreign matter by phagocytosis
o Neupogen, medications (Injection)
▪ Stimulates production of neutrophils
▪ Uses: neutropenia and when bone marrow is suppressed and in patients with transplant
(subcutaneous and IV)
▪ Nursing interventions: monitor neutrophil levels and count, DO NOT ADMINISTER WITH
