hemato

neoplasms

benign tumor

no, but neoplastic cells are responsible for making tumors and is a lively growing cell

cancer

cancer cells

contact inhibition

initiation

promotion

Epstein-Barr

carcinoma

carcinoma

sarcoma

leukemia

in situ

metastasis

• 1. invation of blood or lymph vessels
• 2. movement by mechanical means
• 3. lodging and growing in a new location

• long term use of estrogen
• chronic irritation
• high-fat, low-fiber diets
• altered immunity
• chemicals
• radiation
• virii
• genetics

• carry the cell characteristics of the original tumor site
• lung tissue found in brain suggests a primary lung tumor with metastasis to brain tissue

21 and every 1 to 2 years after

removes small amount of tissue for inspection

removes entire tissue mass

insertion of needle to remove fluid or aspirate tissue

• evaluates lesions in brain or breast
• biopsy site immobilized
• site is scanned for location and a fiber optic instrument inserted

• sample is removed during surgery
• sample is frozen for microscopic examination
• provides quick analysis and directs remainder of  surgical procedure

tumor-node-metastasis

• tumor: TX (tumor cant be evaluated), T0 (no evidence of primary tumor), Tis (carcinoma in situ), T1,2,3,4 (size and/or extent of primary tumor)
• regional lymph node: NX (lymph nodes cant be evaluated), N0 (no cancer found), N1,2,3 (# and/or extent  of spread)
• distant metastasis: MX (cant be evaluated), M0 (no distant metastasis), M1 (distant metastasis)

• fatigue
• nausea, vomiting and anorexia
• mucositis
• xerostomia
• desquamation
• bone marrow depression

• inflammation of mucous membranes, especially of the mouth and throat
• advise pt to perform mouth care before meals and every 3 to 4 hours

• dry mouth
• encourage frequent mouth care

• skin peels from radiation, varies to mild redness and moistness
• keep skin dry, free from irritants and protect from exposure to direct sunlight
• desquamation irritants are powder, lotions and restrictive clothing

• increases effectiveness
• decreases side effects and  and possiblity of tumor becoming resistant

fast growing epithelial cells such as hair, blood, skin and GI tract

• leukopenia or neutropenia
• neutrophils respond to bacterial infections and are the most plentiful

thrombocytopenia

stomatitits

• 150,000 - 300,000
• potential for bleeding at 50,000
• spontaneous bleeding at 20,000

• give numega which stimulates platelet production
• avoid IM, subQ and rectal meds
• apply pressure for at least 5 min to venipuncture or injection sites
• teach the pt about gentle oral care, no flossing
• avoid trauma to rectal tissue
• no NSAIDS or aspirin
• no sex
• observe for bruising, petechiae, bleeding gums, tarry stools and black emesis

• it is an objective measurement to determine if intake is enough to maintain weight
• weight gain is also a possible sign of fluid retention

• small, high calorie meals; prevents pt from feeling full and nauseated
• room temp or cold foods; have fewer odors and are more comfortable to eat
• sour foods help control nausea

stimulates production of RBCs

• tumor from lung cancer or cancers of the mediastinum block circulation in the vena cava
• causes edema of head, neck and arms
• symptoms: shortness of breath, cough, chest pain, facial redness, and swollen neck veins

• hypercalcemina; Ca ions leech into the blood
• IV meds and hydration lower the concentration

• abnormal activation of the clot formation and fibrin mechanisms in the blood use up all the coagulation factors and platelets
• pt is placed on bleeding precautions and at high risk for thrombus formation

petechiae

purpura

iliac crest, sternum and spinous process of vertebrae

• 2 nurses are required
• all info for the pt and what's listed on blood bag must match 
• 18 or 20 gauge catheteris required
• only normal saline is allowed to piggyback
• allow 2 - 4 hrs for transfusion
• monitor pt for first 15 minutes

iron, folic acid and vitamin B12

• impaired RBC product, i.e. aplastic anemia
• increased destrucion of RBC, i.e. hemolytic or sickle cell anemia
• massive or chronic blood loss

• anemia
• all if not most represent poor oxygenation

numbness in hands or feet and weakness, fissures at corners of mouth, an inflamed tongue (glossitis) and spoon shaped fingernails

• red meat
• dark green leafy vegetables
• dried fruits
• enriched, fortified or whole-grain products

ingest vitamin c and stewing acidic foods in iron cookware

liver, green leafy vegetables, legumes and enriched grain products

• derived from animal sources
• meat, fish and shellfish, poultry and milk

• manufacture of RBCs
• maintenance of myelin which facilitates the transmission of nerve impulses

change cooking habits, take dietary supplements, decrease alcohol intake

yes

nausea, diarrhea, constipation and dark stools

• bone marrow becomes fatty and incapable of producing adequate amounts of RBC
• results in pancytopenia

pancytopenia

progressive weakness, fatigue, pallor, shortness of breath and headaches

• bone marrow transplant, steroid therapy and colony stimulating factors
• colony stimulating factors: epogen, filgrastim, neupogen

• mutation in RBC makes hemoglobin sensitive to oxygen changes.  
• Times of low oxygenation or high stress change RBCs into sickles that are rigid and easily broken

• private room
• staff and visitors must wash hands before entering room
• pt must wash hands before and after toileting as well as before and after eating
• prevent ppl with infections from entering the room
• pt must not handle flowers and can't have plants in her room
• pt must avoid raw fruits, vegetables and milk products
• avoid use of indwelling urinary catheters and other invasive devices
• use strict aseptic technique when performing invasive procedures
• use acetaminophen if an antipyretic is needed; aspirin can induce bleeding

• use an electric razor
• soft toothbrush or gauze to clean teeth
• avoid invasive procedures including enema, douches, suppositories and rectal temps
• avoid IM injections
• avoid blood draws and try to draw only once per day
• maintain pressure on IV, blood draw and other puncture sites for 5 minutes
• encourage use of slippers or shoes when out of bed
• keep area clutter free to prevent bumps and bruises
• avoid drugs that interfere with platelet function such as aspirin and NSAIDS
• give stool softeners
• turn pt gently to avoid bruising
• pt should blow nose gently and only when necessary
• consult physician on whether sex is safe

• pneumonia with hypoxia
• exposure to cold
• diabetic ketoacidosis
• severe infection
• anesthesia and blood loss during surgery
• postoperative dehydration

• severe pain and swelling in the joints, abdominal pain (swelling of spleen and vital organs), hypoxia, fever, pain, priapism
• symptoms of renal failure

• encourage fluids to dilute and aid in eliminating cell debris
• warm compress to painful areas, cover pt with a blanket and keep room above 72 F to reduce vasoconstriction
• avoid cold compresses which cause vasoconstriction and may trap additional sickled cells
• avoid restrictive clothing and raising the knee gatch of the bed

aspirin, it may increase acidosis which can worsen the crisis

• avoid tight fitting clothing that restricts circulation
• avoid strenuous exercise
• avoid things that cause vasoconstriction such as smoking and the cold
• avoid alcohol
• encourage fluids to maintain hydration and lower blood viscosity

Polycythemia 

• long term hypoxia which causes the pt to make more RBCs
• COPD, cardiovascular problems such as chronic heart failure, living in high altitudes and smoking

hemoglobin greater than 18mg/dl, hematocrit > 55%

• most issues are related hypervolemia, hyperviscosity and engorgement of the capillary bed
• htn, vision changes, headache, vertigo, dizziness, and ringing in the ears
• nosebleeds, bleeding gums, retinal hemorrhage, exertional dyspnea, chest pain

• increased level of all bone marrow components (RBC, WBC,  platelets)
• associated with polycythemia

• therapeutic phlebotomy; 350 - 500 mL removed every other day (goal is hematocrit = 45%)
• low dose aspirin to reduce thrombus formation
• chemotherapy or radiation to reduce production of WBCs 

drink at least 3L of water, smoking cessation, avoid tight clothing, elevate feet when resting, ambulate frequently

• accelerated clotting causes all clotting factors and platelet supplies to be exhausted and clots can no longer be formed
• organ and limb necrosis is caused by massive clotting in blood vessels
• develops secondary to major trauma

major trauma; overwhelming infection, abruptio placentae, leukemia, severe crush injuries, etc

blood, fresh frozen plasma, platelets, vitamin K, cryoprecipitate

increased platelet destruction by the immune system

usually occurs after an acute viral illness such as rubella or chickenpox, may also be drug induced or associated with pregnancy

• give steroids to prolong platelet life
• remove spleen; primary site of platelet destruction
• acute episodes treated with blood transfusion, platelets and vitamin k

• hereditary bleeding disorders that result from a lack of specific clotting factors
• hemophilia is a deficiency of clotting factor VIII
• hemophilia is a deficiency of clotting factor IX

• ppl bleed faster
• they are at risk from small scratches

bleeding into muscles and joints, repeated episodes may cause deformities

• inhalation of desmopressin
• providing pt with clotting factors (IX or VIII)

• mild: excessive bleeding is associated with surgery or significant trauma
• moderate: occasional spontaneous bleeding
• severe: more frequent spontaneous bleeding

• too many immature WBCs are created by bone marrow
• reduced RBC production
• pt is anemic and prone to infections

• cancerous plasma cells cause tumors in bone tissue and weaken them
• bones of the skull, pelvis, ribs and vertebrae are usually affected

• skeletal pain, joint swelling and tenderness, low grade fever, 
• hypercalcemia because calcium leaves the bones
• kidney failure due to excess calcium in bones

• keep pt mobile to keep calcium within bones
• intake more than 4L daily
• give enough fluids so pt excretes 1500 mL of urine

• corticosteroids and oral or IV chemotherapy
• monitor for hypercalcemia, hyperuricemia, dehydration, respiratory infection, renal problems and pain

• reed-sternberg cells found in lymph system
• most curable
• usually starts with painlessly enlarged lymph nodes of cervical, axillary and inguinal areas
• most common in pts that had mononucleosis
• alcohol induced pain

• no reed-sternberg cells
• usually starts with painlessly enlarged lymph nodes of cervical, axillary and inguinal areas
• cancer cells may be found in other lymph tissue (tonsils, thymus or bone marrow)