Medical Nursing I – Leukemia Overview

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Questions and Answers

What should be avoided when caring for a patient with conditions that inhibit platelet function?

Suctioning unless absolutely necessary (correct)

Ambulating the patient without assistance

Taking rectal temperatures (correct)

Using an electric razor for shaving

Which intervention is NOT advisable for a patient at risk of bleeding?

Administering platelets as prescribed

Using only soft-bristled toothbrush for oral hygiene

Applying direct pressure to bleeding sites

Inserting indwelling catheters (correct)

What position should a patient with epistaxis be placed in to help control bleeding?

Trendelenburg position

Supine position

Lateral position

High Fowler's position (correct)

Which of the following does NOT constitute a priority nursing diagnosis for a patient newly diagnosed with leukemia?

Ineffective airway clearance Signup and view all the answers

Which of the following is NOT part of the management for controlling constipation in a patient at risk for bleeding?

Providing enemas as needed Signup and view all the answers

What is the primary focus of care for a patient diagnosed with leukemia?

Managing risk for infection and bleeding Signup and view all the answers

Which lab test is least necessary for the diagnosis of chronic myelocytic leukemia?

Blood culture Signup and view all the answers

What type of items should a nurse recommend to a patient for oral hygiene in the context of a bleeding disorder?

Soft-bristled toothbrush Signup and view all the answers

What is a common risk factor associated with the development of leukaemia?

Environmental exposure to ionizing radiation Signup and view all the answers

Which type of leukaemia is characterized by an acute onset and the presence of immature blast cells?

Acute Lymphoblastic Leukaemia Signup and view all the answers

Which cell type primarily fights bacterial infections and is considered essential in this role?

Neutrophil Signup and view all the answers

What is the average lifespan of an erythrocyte in the human body?

120 days Signup and view all the answers

Which leukaemia is most commonly associated with the Philadelphia chromosome?

Chronic Myelocytic Leukaemia Signup and view all the answers

What is a common manifestation of Acute Myeloblastic Leukaemia?

Epistaxis (nosebleed) Signup and view all the answers

Which nursing diagnosis is most appropriate for a patient with leukaemia experiencing severe malaise and anorexia?

Imbalanced nutrition, less than body requirements Signup and view all the answers

What is the primary treatment approach for leukaemia?

Chemotherapy and possibly radiation Signup and view all the answers

What symptom is specifically related to thrombocytopaenia in a leukaemia patient?

Gastrointestinal bleeding Signup and view all the answers

Which leukaemia is characterized by the accumulation of small, abnormal, mature lymphocytes?

Chronic Lymphocytic Leukaemia Signup and view all the answers

Study Notes

Introduction to Leukaemia

Abnormal overproduction of leukocytes occurs primarily in the bone marrow.
Immature white blood cells (WBCs), known as blast cells, proliferate and suppress normal bone marrow function.
Main characteristics include:
- Replacement of normal bone marrow with malignant immature WBCs.
- Presence of abnormal immature circulating WBCs.
- Infiltration into organs such as the liver, spleen, and lymph nodes.

Causes and Risk Factors

Etiology is often unknown; potential genetic damage leads to malignancy.
Risk factors encompass:
- Genetic predispositions (e.g., Down syndrome).
- Viral infections (e.g., HTLV-1).
- History of aggressive chemotherapy affecting the immune system.
- Environmental exposures, including ionizing radiation, benzene, and certain medications.

Cell Types and Functions

Key white blood cell types and their roles:
- Neutrophils: Prevent bacterial infections via phagocytosis.
- Monocytes: Differentiate into macrophages, important in fungal defense and immune surveillance.
- Eosinophils: Engage in allergic reactions by neutralizing histamine and digesting foreign proteins.
- Basophils: Contain histamine, crucial for hypersensitivity responses.
- Lymphocytes: Vital part of the immune system, with subtypes:
  - T lymphocytes: Mediate cell-mediated immunity.
  - B lymphocytes: Generate antibodies; develop into plasma cells.
- Plasma cells: Secrete immunoglobulins (antibodies).
Erythrocytes (RBCs): Carry oxygen via hemoglobin; average lifespan is 120 days.
Platelets (Thrombocytes): Essential for blood coagulation; average lifespan is 10 days.

Classification of Leukaemias

Classifications are based on acuity and cell types:
- Acute Leukaemias: Rapid onset with immature cells; untreated often fatal within weeks.
- Chronic Leukaemias: Slower progression with mostly mature leukocytes; generally better prognosis.
- Lymphocytic (Lymphoblastic): Affects immature lymphocytes.
- Myelocytic (Myeloblastic): Involves myeloid stem cells, impacting development of blood cells.
- Types include acute myeloblastic, chronic myelocytic, acute lymphoblastic, and chronic lymphocytic leukaemia.

Types of Leukaemia

Acute Myeloblastic Leukaemia (AML)

Characterized by excess myeloblast proliferation and hyperplasia of bone marrow and spleen.
Symptoms include fever, infections, bleeding, and weight loss.
Diagnoses reveal immature blast cells and thrombocytopaenia.

Chronic Myelocytic Leukaemia (CML)

Result of myeloid stem cell mutation, often linked to the Philadelphia chromosome translocation.
Symptoms can be mild but include fatigue and splenomegaly.
Exhibits three phases: chronic, transformation, and terminal blast crisis.

Acute Lymphoblastic Leukaemia (ALL)

Rapidly proliferates precursor B or T lymphocytes; common in children.
Symptoms include headaches, vomiting, and pain due to organ infiltration.

Chronic Lymphocytic Leukaemia (CLL)

Accumulation of abnormal, mature lymphocytes, predominantly B lymphocytes.
Manifestations include fatigue, infections, and abdominal pain.

Diagnostic Investigations

Full blood count may show a normal leukocyte count with decreased normal cell percentages.
Bone marrow aspiration/biopsy assesses disease characteristics and extent.
Lumbar puncture may evaluate central nervous system involvement, particularly for ALL.

Treatment Approaches

Primarily involves chemotherapy, with possible radiation and stem cell transplantation.
Phases of chemotherapy include induction, intensification, CNS prophylactic, and maintenance.

Nursing Diagnoses and Management

Priority nursing diagnoses may include risk for infection and impaired physical mobility due to isolation.
Nursing management focuses on preventing and managing infections and bleeding, effective pain control, and maintaining nutrition and physical activity.

Complications Prevention

Perform oral care with soft-bristled toothbrushes; no flossing allowed.
Avoid medications that inhibit platelet function and use electric razors for shaving.
Apply caution during venipuncture and control any bleeding with direct pressure.

Multiple Choice Questions Insights

Recognizing risk for infection as the priority nursing diagnosis for newly diagnosed leukaemia patients.
Understanding necessary diagnostic investigations for conditions like chronic myelocytic leukaemia, including blood culture and bone marrow aspiration.

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Description

This quiz covers the key concepts related to leukemia, specifically the abnormal overproduction of leukocytes and its effects on bone marrow and surrounding organs. It highlights the characteristics of immature WBC proliferation and their implications in medical nursing. Test your understanding and grasp of this vital topic in nursing.