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When preparing the pt for a bone marrow examination, the nurse explains that:
A) there will be no pain during the procedure but there will be an ache afterward
B) The procedure will be done under general anesthesia because it is so painful
C) the pt will experience a breif sharp pain during aspiration of bone marrow
D) the pt will not have any pain after the area at the puncture aite has been anesthetized
C) the pt will experience a breif sharp pain during aspiration of bone marrow. The actual bone cannot be numbed.
After bone marrow transplantation the pt is at high risk for:
A) bleeding
B) all of the above
C) infection
D) failure to engraft
B) all of the above
The definitive diagnosis for leukemia is:
A) complete blood cell count
B) Lumbar puncture
C) Bone marrow aspiration
D) Total platelet count
C) Bone marrow aspiration
Leaukemia occurs when stem cells in the bone maroow produce:
A) immature erythrocytes that cannot function
B) immature WBC that cannot function
C) LArge number of platelets
D) Large number of RBC
B) immature WBC that cannot function
A pt with acute myelogenous leukemia is to start chemo. During the induction stage of chemo the nurse can expect the pt to:
experience additive bone marrow suppression. Bone marrow is suppressed by the drugs used in the induction stage. SE can be very intense. PT can get very ill and a very high risk for infection duirng induction stage dt increased immunosuppression.
Lymphadenopathy, splenomegly, and hepatomegaly are common clinical manifestations of leukemia that are due to:
A) increased compensatory production of blood cells by these organs
B) the development of infections at these sites
C) infiltration of the organs by increased number of WBC''s in the blood
C) infiltration of the organs by increased number of WBC''s in the blood
All of the following characteristics of acute lymphocytic leukemia EXCEPT:
A) proliferation of immature lymphocytes in bone marrow
B) CNS manifestations are common
C) Associated with Philadelphia chromosome
D) most common in children
C) Philadelphia chromosome is associated with Chronic Myelogenous Leukemia (CML)NOT lymphotic leaukemias.
Primary treatment for cure of leukemia include?
chemotherapy and bone marrow transplantation
Donor cells can be obtained by what methods
1) traditional bone marrow harvesting
2) (PBSCT)peripheral blood stem cell transplantation
traditional bone marrow harvesting
large amounts of bone marrow under general anesthesia
(PBSCT) peripheral blood stem cell transplantation
widespread use, cost effective, safe, uses aphresis of the donor to collect peripheral blood stem cells.
Types of bone marrow transplant
-Allogenic
-Autologous
-Syngeneic
Allogenic
(from a donor other than pt) either a related donor (family member) or a matched unrelated donor (national bone marrow registery, cord blood registry)
Autologous
from pt
Syngeneic
from an identical twin
Advantage of allogeneic donor?
the transplanted donor cells should not be immunologically tolerant of pt malignancey and should cause a graft-vs-disease effect in malignant cells.
graft -vs-host disease (GVHD)
when T lymphocytes from the donor cells activate and attack the recipienats tissues. Theyy do this because they view the recipients tissue as different from "self"
autologous
for people who do not have a suitable donor or for people who have healthy bone marrow but aggressive melignancy that requires bone marrow-ablative doses of chemo to cure aggressive chemo.
VOD
Venous Occlusive Disease, a vascular injury to the liver caused by high doses of chemo
Care prior to BMT
-nutritional assessment
-Extensive physical exam
-organ function tests
-psychological function tests
Blood work including
-past antigen exposure (hepatitis, HIV, herpes ect)
-social support systems
-financial and insurance resources
-informed consent and pt teaching about pre and post transplantation are essential
Providing care DURING BMT
Close monitoring and close attention dt high-dose chemo and total body irradiation. Can cause nausea, diarrhea, mucositis, hemorrhagic bleeding.
Care during BMT aplasia
-High risk for dying dt sepsis or bleeding
-support with blood products and hemopoietic growth factors
-potential infections can be fungal, viral, bacterial or protozoan in nature
-renal complications from nephrotoxic chemo agents used
-Tumor Lysis syndrome
-acute tubular necrosis
Nursing assessment to detect early S&S of problems
skin, liver and GI tract. VOD can result in fluid retention, jaundice, ABD pain, Ascitis, tender enlarged liver, encephalopathy, pulmonary edema, interstitual pneumonia, and other pneumonias
POST BMT
follow up visits important -essential to detect late effects 100 days or more after procedure. Late effects include infections, restrictive pulmonary abnormalties, and recurrent pneumonias. psychosocial evaluation of pt and family
Care for donors
may have feelings of failure of rejection takes place
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