Non hodgkins lymphoma/ myeloma

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  1. NHL
    • group of malignant lymphoma that affects all ages
    • - on the incre especially in older adults > 50yrs old
    • classified as indolent (slow growing) or aggressive (rapid growing)
    • cause is unclear
    • more common than hodgkins
    • it affects t and b cells
    • spreads no continous
    • tends to be painless and passive (indolent)- we usually pick up in late stage
  2. NHL
    risk factors
    • long term immunosupressant therapy
    • bone marrow transplant
    • previous hodgkins therapy, rad tx
    • r/a (autoimmune)
    • fhx
    • exposure to pesticides solvents
  3. NHL
    how it works
    • neoplastic growth of lymphoid tissue
    • - lymphoid tissue infiltrated with malig cells
    • - multiple sites
    • spreads in unpredictable way- non continuous
    • starts in one lymph node
    • spreads by lymph and vascular system
  4. NHL s/s
    • *** hallmark painless lymph node enlargement- usually a chain not one node but chain of nodes
    •  aggressive- usually sicker sooner- fever, sweats, wt loss, unexplained abd/chest/bone pain- b symptoms
    • indolent- usually has widespread disease, more difficult to treat
    • - may have signs associated with metastasis
    • - pulm involvement SVC syndrome- compliants of swelling in face
    • it can wax and wane (problematic and then goes away)
  5. NHL diagnostic n staging
    • much like hodgkins
    • ** no Reed-Sternberg cells
    • prognosis no as good as hodgkins
    • 50/50
  6. NHL
    • tx medical
    • xrt
    • chemo
    • Biologic therapies(targeted tx)
    • - monoclonal antibodies (changing the immune response
    • - stem cell transplant
  7. NHL
    nursing management
    • similar to hodgkins
    • minimize infection
    • pt teaching
    • support
    • think about pt who have chemo or radiation
  8. multiple myeloma
    • cancer of the bone marrow
    • fatal within two yrs if untreated
    • cause unknown
    • - more common in men, african american, us onset after 40 yrs
    • older adult
    • incr risk if exposed to radiation, organic chemicals, herbicides, insecticides
  9. multiple myeloma
    • it involve plasma cell- b lymphocytes
    • 1. multiply uncontrollible
    • 2. infiltrate the BM, (incre risk of osteomalacia, infec, pancytopenia)
    • 3. secrete abnormal protein- bence jones protein or M protein- change in immune response (infection), incre blood viscosity (clotting)
    • - seen in blood or urine
    • effects the kidneys, spleen, lymph nodes, liver, heart, spinal
    • it could spread directly or by the blood
  10. multiple myeloma
    • develop slowly, not seen until advance disease
    • older adult that complains of acute back pain (fracture, osteomalacia), with anemia, and increased proteins (total protein)
    • - think multiple myeloma
  11. multiple myeloma
    s/s advance disease
    • *** skeletal pain, diffuse osteoporosis, compression and pathologic fractures
    • hypercalcemia- fractures, bone fracture
    • renal failure- protein
    • anemia, thrombocytopenia and neutrapenia
    • thrombosis+
  12. Myeloma
    • Calcium is high
    • Renal insufficiency/failure (proteins damage tubles)
    • A- anemia (think about bone marrow)
    • B- boney lesion- facture, osteomalacia
  13. Myeloma
    • pancytopenia
    • hypercalcemia, hyperuricemia (destruction of tissue)
    • elevated crt, proteinuria
    • - + bence- jones protein in urine
    •  xray
    • bone marrow- eleva plasma cells (bc u loss bone cells)
  14. Bone marrow biopsy
    • anxiolytic PRN- must stay still
    • pt may feel pressure but no pain
    • pressure to site for several minutes after
    • sterile dressing
    • site may ache for 1-2 days
  15. Bone marrow biopsy
    post care
    • look at ATI and text book
    • nursing assessments and priorities
    • complications
    • pt teaching
  16. Multiple myeloma
    • seldom cured
    • treatment may prolong and improve quality of life- chemo, biologic therapy, stem cells
    • watchful waiting may be appropriate
  17. Multiple myeloma
    • ambulation weight bearing activities- keep calcium in bones
    • hydration- push po/IV fluids- goal 2-3L a day of output to excrete the calcium
    • - perfuse the kidney and prevent
    • hypercalcemia crisis
    • - think about symptoms of hypercalcemia- groans, moans, bones
    • analgesics/pain management
    • allopurinol: decrease uric acid- give 2-3L of waters
    • fosamax- keeps calcium in bone
    • infection prevention
    • safety precaution and gentle turning- bc osteoporosis
    • orthopedia supports
    • local radiation
    • dialysis
    • psychosocial support/teaching
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Non hodgkins lymphoma/ myeloma
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