Term
What tissues are likely to be affected by leukemia? |
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Definition
Highly vascularized organs: liver, spleen, lymph, bone marrow |
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Term
What are some S/S of leukemia? |
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Definition
profound anemia infection with left shift (increase in immature neutrophils) bleeding (petechiae anywhere that clothing tight) |
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Term
What is the pathophysiology of leukemia? |
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Definition
Unrestricted proliferation of immature WBCs that act like a "circulating tumor" and can send out "fingers" into different organ systems and then compete for metabolic elements causing destruction to tissue around it. |
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Term
With leukemia, what would you see in a complete WBC count? |
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Definition
Leukocytosis (increased WBC count >10,000) with very low percentage of mature WBCs |
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Term
What is the end result of leukemic invasion of spleen, liver, and lypmph glands? |
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Definition
hepatosplenomegaly and fibrosis |
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Term
What is a possible cause of pathological fractures? How? |
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Definition
Leukemia Invading leukemic cells into bone marrow causes weakening |
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Term
What is the chemotherapy Tx for acute lymphoid leukemia? What is the goal? |
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Definition
4-6 weeks corticosteroids, vincristine, L-aspariginase and maybe doxorubicin goal: remission or decrease cells to 5% |
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Term
What is the chemotherapy Tx for AML (ANLL)? |
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Definition
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Term
What are 3 Tx's for leukemia? |
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Definition
chemotherapy steroids hematopoietic stem cell transplantation (bone marrow transplant) |
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Term
What are the 3-5 phases of chemotherapy for leukemia? |
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Definition
1)Induction therapy lasts 4-6 wks. Goal is to put into remission or decrease cells to 5% 2)Intesification therapy: after remission, Tx is intensified to eradicate remaining leukemic cells 3)Maintenance: daily and weekly IV,IM, and intrathecal meds for 2 yrs 4)Possible CNS prophylactic therapy 5)Possible relapse induction |
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Term
Why are steroids part of Leukemia Tx? |
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Definition
stop bone marrow from producing WBCs counteract inflammation from chemo |
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Term
What therapy is only for high risk leukemia Pts? Explain. |
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Definition
CNS prophylactic therapy: intrathecal methotraxate and cytarabine *injected into spinal column so X's blood-brain barrier for pts who have plaques in CSF or brain *it can kill Pts, so needs lots of checks |
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Term
Who must be in the room during CNS prophylactic therapy for leukemia Pts? |
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Definition
If the parent cannot handle being in the room, a play therapist or someone the child trusts must be there to help/hold hand/distract child |
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Term
What factors would indicate a better prognosis in a leukemia Pt? |
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Definition
*Normal or low initial WBC count *Onset at 2-9 yrs rather than before 2 or after 10 *female *DNA index >1.16 and translocation of chromosomes 4 and 10 |
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Term
What are chemotherapy drugs? |
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Definition
antimetabolites that affect fast proliferating cells such as hair, nail, GI, bone marrow cells |
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Term
What are some relatively immediate side effects of chemotherapy? |
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Definition
alopecia, sores in GI tract from mouth to anus, GI bleeds, gastric pain, vomiting blood, lines on nails |
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Term
What pain medication is needed to deal with the side effects of chemotherapy? |
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Definition
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Term
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Definition
Period of 7-12 days after chemotherapy when there is pancytopenia (wiped-out bone marrow) and sometimes no WBCs which means the chemo is working. |
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Term
What are some late side-effects of cancer Tx? |
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Definition
*anthracycline causes *chemo and radiation effect all organs negatively (e.g. brain growth effected and interferes in cognitive development) *secondary malignancy-lymphoma *cranial radiation before 5:risk malignant brain tumor cardiomyopathy *intrathecal chemo->cognitive delays |
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Term
What do parents need to be aware of during chemotherapy? |
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Definition
*pathology *S/S of sepsis - if worried bring in, especially duing nadar *drugs and side effects *when to seek emergency medical help *how to optimize growth and development |
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