Leukemia/Lymphomas
Cancer of the lymphatic system
What are lymphomas?
A patient is considered neutropenic if their neutrophil count is less than:
a) 1.0
b).2.0
c).5.0
d). 3.0
A.
Neutropenia means a low neutrophil count. The normal range for neutrophils is 2.5-7.5 x 10 9 /L. Moderate neutropenia is defined as a neutrophil count of 0.5-1.0 x 10 9 /L. Severe neutropenia is a count of <0.5 x 10 9 /L
What is the life span of a RBC
120 days
A TRANSFUSION REACTION USUALLY OCCURS WITHIN THE FIRST _______ OF THE INFUSION.
10-15 minutes
A client taking a chemotherapeutic agent understands the effects of therapy by stating:
Correct Answer: B. “I will avoid eating hot and spicy foods.”
A chronic leukemia that is very slow growing, usually not treated for a long time and is often not what people die of when they have it as a diagnosis
Chronic Lymphocytic Leukemia (CLL)
Name 3 things you can anticipate being ordered for you patient during a neutropenic fever workup ?
-UA
-blood cultures (arterial and any site -PICC, dialysis line, etc.)
-Xray
-if any artificial implants (prosthesis, valve, etc)may need ECHO, Hip Xray, head plate xray, etc. to help determine cause.
-antibiotics, antiviral, antifungals
What is Pancytopenia?
decrease of all types of blood cells
RBC, WBC, Platelets
If the nurse suspects a transfusion reaction, the following actions should occur: (select all)
a) Stop the blood
b)call the transfusion department
c)call the physician
d) leave the blood connected but stopped
e) Put the blood in the red bin
f) provide supportive cares
A, b, c, f.
You would unhook the blood and flush the line but do not discard the blood so that it can be worked up for the reaction.
A. A HGB over 7 is usually considered stable unless they are symptomatic
Which is not a risk factor for Multiple Myeloma?
A. Toxin and hazardous chemical exposure
B. obesity
C. genetics
D. being female
D. Multiple Myeloma usually affects Males >50 years
Your patient's family member brought some chocolates and flowers for your patient who is admitted for neutropenic fever. Describe your response?
Chocolates ok if individually wrapped
flowers are not ok due to fungal infection risk
You can anticipate your patient with severe thrombocytopenia may be ordered?
Platelets
The physician has ordered 2 URBC and some lasix to prevent fluid overload. The patient has one IV. Can you give these both at the same time?
No-- blood should be given in it's own line, not piggybacked with anything except NS as a flush. Nurses should consider the need for a second IV for additional medications.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following?
D: A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage.
What are the 4 main types of leukemia?
Acute Myoclonic Leukemia (AML)
Acute Lymphocytic Leukemia (ALL)
Chronic Myoclonic Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
Neutropenia plus ___________________ is considered a medical emergency
Fever >100.4
C. O+ and A+ are NOT compatible blood types. Patients with O+ can only receive blood from others with O blood. This patient is at risk for a hemolytic reaction. This is where the immune system is killing the donors RBCs. The antibodies in the recipient’s blood match the antigens on the donor’s blood cells….the patient has been mistyped!!
D. If any IV medications will be needed while the blood is transfusing, the nurse will need to start another IV access site. The nurse would NEVER administer the IV antibiotic in the same tubing as the blood product or stop the transfusion. Remember blood is time sensitive and must be transfused within 4 hours. Also, holding the antibiotic is not correct because antibiotics are time sensitive as well and must be administered at the scheduled time to maintain blood levels.
You answer another nurse's call light and notice that the patient has a hazardous medication precautions sign at the door. The patient states that he needs to go to the bathroom. What steps can you anticipate doing to ensure a safe environment:
1. Put on double nitrile gloves
2. Put on N95
3. Tell the patient you cannot touch help him because he just received chemo
4. Double flush and use toilet cover
4. You would not need to double glove. One pair is sufficient. Only need face shield /mask if possibility of splashes of body fluids. N95 is not needed. 4. You have to ensure safety and are able to touch the patient if you have proper attire.
Your patient has a new diagnosis of ______. Her daughter tells you that she has suffered several falls and fractures in the past year.
Multiple Myeloma.
Multiple myeloma occurs in the bone marrow and can cause soft spots in the bone called osteolytic lesions, which appear as holes on an X-ray. These osteolytic lesions are painful and can increase the risk of painful breaks or fractures.
Name 3 teaching points for patients with neutropenia
handwashing
dietary considerations (drink bottled water, avoid fresh fruit, raw meat, buffets)
when to contact MD: fever, chills,, cough, etc.
avoiding crowds, avoid sick people, pet care
N95 outside, after room cleaned for 30 min
You are caring for a client with an ongoing transfusion of packed RBC’s when suddenly the client is having difficulty of breathing, skin is flushed and having chills. Which action should nurse Jay take first?
Stop the transfusion. The client in this situation is experiencing transfusion reaction so the priority action of the nurse is to first stop the transfusion.
Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction:
A. Sweating
B. Chills
C. Hives
D. Poikilothermia
E. Tinnitus
F. Headache
G. Back pain
H. Pruritus
I. Paresthesia
J. Shortness of Breath
K. Nausea
The answers are A, B, C, F, G, H, J, and K. As the nurse you want to educate the patient to report signs and symptoms associated with blood transfusion reactions, which would include: sweating, chills, hives, headache, back pain, pruritus (itching), shortness of breath, and nausea.
A patient is receiving chemotherapy for the treatment of cancer. The nurse anticipates nadir to occur in
A. 2 days.
B. 8 days.
C. 15 days.
D. 30 days
C. Nadir is the time when blood counts are at their lowest.