TOPIC 6 - leukemia Flashcards
leukemia affects …
blood and blood forming tissues of the bone marrow
lymph system
spleen
causes of leukemia
mutation in the DNA
genetic and environmental influence
abnormal genes
chemical agents
chemotherapeutic agents
viruses
radiation
immunologic
persons previously treated with radiation or chemotherapy
affect of leukemia on erythrocytes
anemia
= weakness + pallor
affect of leukemia on lymphocytes
immunosuppression
= infection + fever
affect of leukemia on platelets
bleeding, decreased clotting, thrombocytopenia
= petechiae, bruising, purpura
common affected sites
CNS, testicles, lymph nodes, liver, spleen, joints
classifications of leukemia
acute : clonal proliferation of immature hematopoietic cells
chronic : mature forms of WBC and onset is more gradual
lymphocytic or myelogenous
chronic myelogenous leukemia causes
caused by excessive development of mature neoplastic granulocytes in the bone marrow
chronic myelogenous leukemia outcomes
the excess neoplastic granulocytes move into the peripheral blood flow and infiltrate the liver and spleen
stages of CML
chronic stable: can last for several years and be well controlled with meds
acute, aggressive phase: must be treated more aggressively
diagnostic hallmark of CML
philadelphia chromosome
CML clinical manifestations
no symptoms early on
fatigue, fever, sternal tender, weight loss, joint pain, bone pain, massive splenomegaly, increase sweating
diagnostic findings of CML
low RBC, low Hgb, low Hct, high platelet early on/ low platelet later on, increased banded neut + myeloblasts + basophils, normal lymph, normal or low monocytes
chronic lymphocytic leukemia is characterized by …
production and accumulation of functionally inactive but long lived small, mature appearing lymphocytes. B cells are usually involved
lymphocytes infiltrate the bone marrow, spleen, and liver
complications of CLL
rare early on but develop as disease advances
pressure on nerves = pain, paralysis
mediastinal node enlargement leads to pulmonary symptoms
chronic lymphocytic leukemia manifestations
frequently no symptoms
chronic fatigue, anorexia, splenomegaly, lymphadenopathy, hepatomegaly, fever, night sweats, weight loss, frequent infections
CLL diagnostic findings
mild anemia and thrombocytopenia
WBC > 100,000
increase in peripheral lymphocytes and lymph in bone marrow
leukemic cells infiltrating organs =
splenomegaly, hepatomegaly, lymphadenopathy, bone pain, meningeal irritation, oral lesions
CNS symptoms
vomiting, headache, lethargy, seizure, coma, blurred vision
leukostasis
high leukemic WBC
causes blood to thicken and potentially block circulatory pathways
life threatening
diagnostic studies to determine leukemia diagnosis
peripheral blood evaluation
bone marrow exam
lumbar puncture and CT scan to detect leukemic cells outside of blood and bone marrow
bone marrow examination
involves removal of bone marrow through a locally anesthetized site to evaluate status of blood forming tissue
before: explain procedure, consent, time out is done, analgesic admin
after: apply pressure dressing, assess site
after each relapse, the succeeding remission …
is more difficult to achieve and shorter in duration
treatment
chemo is mainstay
other meds: corticosteroids
radiation therapy
leukostasis treatment: leukaperesis, hydroxyurea
nursing diagnosis
fatigue or activity intolerance
ineffective protection related to abnormal blood profile
risk for infection
knowledge deficit
anxiety related to unpredictability of the course of disease
nursing interventions
maximize patients physical functioning
teaching patients that acute side effects are usually temporary
encourage discussion of quality of life
evaluation
cope effectively
experience no complications
feel comfortable and supported
