Leukemia Flashcards
What is Leukemia?
A group of malignant disorders affecting the blood and
blood-forming tissues of
- Bone marrow
- Lymph system
- Spleen
At what age does Leukemia occur?
Occurs in all age groups
Thought of as a childhood disease
Number of adults affected is actually 9 times that of children
How does Leukemia occur?
Accumulation of dysfunctional cells due to loss of regulation in cell division
Fatal if untreated
What is the cause of Leukemia?
No single cause
Combination of genetic and environmental influences
PAthophysiology of Leukemia picture
Classification of Leukemia
Acute versus Chronic
Based on type of WBC
Acute Leukemia
Acute: Clonal proliferation of immature hematopoietic cells
Chronic Leukemia
Chronic: Mature forms of WBC and onset is more gradual
Types of acute Leukemia
Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
Also called acute nonlymphoblastic leukemia (ANLL)
Types of Chronic Leukemia
Chronic myelogenous leukemia (CML)
Chronic lymphocytic leukemia (CLL)
Acute Myelogenous Leukemia (AML)
Abrupt, dramatic onset
Serious infection or abnormal bleeding
Uncontrolled proliferation of myeloblasts
Hyperplasia of bone marrow and spleen
Acute Lymphocytic Leukemia (ALL)
Most common type of leukemia in children
20% of acute leukemia in adults
Immature, small lymphocytes proliferate in the bone marrow-in children usually
Acute Lymphocytic Leukemia (ALL) S/S
Signs and symptoms may appear
Abruptly
Fever
Bleeding
Insidiously
Progressive weakness, fatigue, pain, bleeding tendencies
CNS manifestations are common-leukemic meningitis
Chronic Myelogenous Leukemia (CML)
Excessive mature neoplastic granulocytes in bone marrow
Move into peripheral blood in massive numbers
Ultimately infiltrate liver and spleen
_Philadelphia chromosome-
Diagnostic hallmark
Present in >90% to 95% CML patients_
Chronic, stable phase
Followed by acute, aggressive phase
Chronic Lymphocytic Leukemia (CLL)
Most common leukemia in adults
Production and accumulation of functionally inactive but long-lived, mature-appearing lymphocytes
B cell involvement
Lymphadenopathy is present throughout body
Complications from early-stage CLL are rare
May develop as disease advances
Pain, paralysis from pressure caused by enlarged lymph nodes
Leukemia Clinical Manifestations
Varied but usually related to
*Bone marrow failure
Overcrowding by abnormal cells-trouble with inadequate production of healthy cells
Inadequate production of normal marrow elements
Formation of leukemic infiltrates*
Leukemia Clinical Manifestations
Inadequate marrow elements cause
Anemia
Thrombocytopenia
Low to high number and altered function of WBCs
What happens as Leukemia progresses
, fewer blood cells are produced
Abnormal WBCs continue to accumulate
Leukemic cells may infiltrate organs
Leukemic cells may infiltrate organs and lead to
Splenomegaly
Hepatomegaly
Leukemic cells may cause
Lymphadenopathy- enlarged lymphnodes
Bone pain
Meningeal irritation
Oral lesions
Solid masses (chloromas)- Collection of leukemic cells
What is Leukostasis
Life-threatening complication
Caused by a high leukemic WBC count in peripheral blood
Blood thickens and blocks circulatory pathways
Leukemia Diagnostic Studies To diagnose and classify types of leukemia
Peripheral blood evaluation
Bone marrow examination
Leukemia Diagnostic Studies To identify cell types and stage
Morphologic, histochemical, immunologic, and cytogenic methods
Leukemia Diagnostic Studies To determine the presence of leukemic cells outside of blood and bone marrow
Lumbar puncture
CT scan
Leukemia Interprofessional Care what is the initial goal
to attain remission
Complete, partial, or molecular
Prognosis is directly related to ability to maintain a remission
Prognosis becomes more unfavorable with each relapse
Leukemia Interprofessional Care treatment
Chemotherapy
Induction: Aggressive TX- Watch for infection and bleeding complications
Postinduction or postremission (consolidation)- Another tx to get whatever remains
Maintenance
Leukemia Interprofessional Care other treatments
Induction Therapy
Consolidation therapy
Maintenance Therapy
Corticosteroids
Radiation therapy
Immunotherapy and targeted therapy
What is Induction Therapy
Attempt to induce remission
Seek to destroy leukemic cells in tissues, peripheral blood, and bone marrow
Patient may become critically ill
Provide psychologic support as well
Postinduction or Postremission chemotherapy
What is Consolidation therapy
Started after remission is achieved
Eliminate remaining leukemic cells that may not be pathologically evident
Maintenance Therapy
Lower doses of the same drugs given every 3 to 4 weeks
Goal is to keep body free of leukemic cells
What is radiation therapy?
Total body radiation in preparation for bone marrow transplantation
Organ- or field-specific such as liver or spleen
Leukemia Hematopoietic Stem Cell Transplant
Goal
Totally eliminate leukemic cells using combinations of chemotherapy with or without total body irradiation
Eradicates patient’s hematopoietic stem cells
Leukemia Stem Cell Transplantation
Replaced with those of an HLA-matched-HUMAN LEUKOCYTE ANTIGEN MATCHED
Sibling-
Volunteer
Identical twin
Or replace with own stem cells
Nursing Management Assessment Subjective data
Past health history
Exposure to toxins, chromosome abnormalities, frequent infections
Medications
Previous chemotherapy
Surgery or radiation treatments
Nursing Management Assessment objective data
Fever, lymphadenopathy, lethargy
Pallor, jaundice, petechiae, ecchymoses
CV - tachycardia, systolic murmurs
GI - oral lesions-PRONE TO INFECTIONS or bleeding, herpes or infection, hepatomegaly, splenomegaly
Seizures, disorientation, confusion
Muscle wasting, bone or joint pain
Nursing Management Assessment diagnostic findings
WBC may be normal or abnormal
Anemia
↓ Hct and Hgb
Thrombocytopenia
Philadelphia chromosome
Hypercellular bone marrow aspirate or biopsy
Nursing Management Planning Overall Goals
Understand and adhere to treatment plan
Experience minimal side effects and complications of disease and treatment
Establish realistic hope and goals, feeling supported during periods of treatment, relapse, and remission
Nursing Management Acute Care
Many physical and psychologic needs
Evokes great fear
Equated with death
Family may need help
Maximize physical function
Provide hope
Encourage discussion of concerns
Special challenges when meeting the intense psychosocial needs of a patient with leukemia
Patient empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life
Involve services of interprofessional team
Nursing Management Acute Care
Review all drugs administered
Be prepared to manage the sometimes life-threatening side effects of treatment-severe infections, bleeding D/O-could bleed out
Assess lab data reflecting effects of drugs and sequelae of the disease
Nursing Management Ambulatory Care
Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse
Nursing Management Ambulatory Care
Teach patient and caregiver
Diligence in disease management
Need for follow-up care
When to seek medical attention- any worsening symptoms or S/S of infection
Nursing Management Ambulatory Care
Goals of rehabilitation
Manage the consequences
Physical
Psychosocial
Social
Spiritual
Nursing Management Evaluation Expected Outcomes
Cope effectively with the diagnosis, treatment regimen, and prognosis
Experience no complications related to the disease or its treatment
Feel comfortable and supported throughout treatment
