Leukemia PDF

Learning objectives: At the end of this lecture the student will be able to: 1. Define of leukemia. 2. Discuss signs and symptoms of leukemia. 3. Describe pathophysiology leukemia. 4. List risk factors of leukemia. 5. Describe diagnosis of leukemia. 6. Describe nursing management.  Definitio...

Learning objectives: At the end of this lecture the student will be able to: 1. Define of leukemia. 2. Discuss signs and symptoms of leukemia. 3. Describe pathophysiology leukemia. 4. List risk factors of leukemia. 5. Describe diagnosis of leukemia. 6. Describe nursing management.  Definition of Leukocytosis: Refers to an increased level of WBCs in the circulation, only one specific cell type is increased. Usually, because the proportions of several types of WBCs are small (eosinophils, basophils, monocytes), only an increase in neutrophils or lymphocytes can be great enough to elevate the total WBC count. Although leukocytosis can be a normal response to increased need (e.g., in acute infection).  Leukemia are malignant disorders of the blood and blood-forming tissues of the bone marrow, lymph system, and spleen. that result in an accumulation of dysfunctional, immature cells that are caused by loss of regulation of cell division. 1. Acute lymphocytic (lymphoblastic) leukemia (ALL): It affects lymphoid cells and involves abnormal growth of the lymphocyte pre\cursors (lymphoblasts). ALL is the most common type of leukemia in young children. 2. Acute myelogenous leukemia (AML): AML affects myeloid cells ‫الخاليا النخاعية‬and grows quickly. It occurs in both adults and children. - Pallor, fatigue, weakness, fever, weight loss, abnormal bleeding and bruising, lymphadenopathy and recurrent infections (in ALL). - Other presenting symptoms, bone and joint pain, headache, splenomegaly, hepatomegaly, neurologic dysfunction.  3.Chronic lymphocytic leukemia (CLL): It affects lymphoid cells and usually grows slowly. People diagnosed with the disease are over age 55. It almost never affects children.  4. Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It mainly affects adults. - Frequently no symptoms. Detection of disease often during examination for unrelated condition. - Chronic fatigue, anorexia, splenomegaly and lymphadenopathy, hepatomegaly. May progress to fever, night sweats, weight loss, fatigue, and frequent infections. The development of leukemia has been associated with:  1. Exposure to ionizing radiation.  2. Exposure to certain chemicals and toxins (eg, benzene, alkylating agents).  3. Familial susceptibility.  4. Genetic disorders (eg, Down syndrome).  5. Smoking cigarettes increases the risk of acute myeloid leukemia.  6. The incidence of leukemia is increased in radiologists, persons who have lived near nuclear bomb test sites or nuclear reactor accidents (e.g., Chernobyl), and persons previously treated with radiation therapy or chemotherapy.  1. Physical exam: checks for swollen lymph nodes, spleen, or liver.  2. Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin.  3. Biopsy: Removes some bone marrow from hipbone or another large bone.  4. Genetic analysis of the peripheral blood and bone marrow components may show the presence of the Philadelphia chromosome in patients with CML A. Chemotherapy:  Many people with leukemia are treated with chemotherapy.  Depending on the type of leukemia, may receive a single drug or a combination of two or more drugs.  B. Radiation therapy:  Radiation therapy (also called radiotherapy) uses high- energy rays to kill leukemia cells.  C. Stem cell transplant:  A stem cell transplant allows patient to be treated with high doses of drugs, radiation, or both.  The high doses destroy both leukemia cells and normal blood cells in the bone marrow.  After patient receive high-dose chemotherapy, radiation therapy, or both, patient receive healthy stem cells through a large vein. (It's like getting a blood transfusion.).  New blood cells develop from the transplanted stem cells.  The new blood cells replace that were destroyed by treatment. Nursing diagnosis:  1. Risk for infection related to altered WBC production and immune function.  2. Ineffective protection related to reduced platelet count and risk for bleeding.  3. Impaired oral mucous membrane secondary to anemia and reduced platelets.  4. Fatigue related to anemia.  5. Anxiety related to fear of leukemia diagnosis  The expected outcomes for the plan of care specify that will:  6. Remain free of infection.  7. Experience no significant bleeding.  8. Have intact oral mucous membranes.  9. Manage self-care activities despite fatigue.  10. Verbalize decreased anxiety. 1. Place in a private room and limit visitors. 2. Instruct all staff, the family, and patient to wash hands. 3. Record vital signs every 4 hours. 4. Avoid invasive procedures unless absolutely necessary. 5. Monitor for bleeding every 4 hours (skin and oral mucosa). 6. Abdominal assessment, body fluids, and menstrual pad count. 7. Perform oral hygiene every 2 hours, using a Soft toothbrush. 8. Instruct to avoid foods that may damage oral mucosa, such as very hot, very cold, or highly acidic or spicy foods. 9. Provide for periods of rest alternating with activity. 10. Teach about the bone marrow biopsy. 11. Allow time for questions and to verbalize fears. The patient is diagnosed with leukemia and has leukocytosis. Which laboratory value would the nurse expect to assess? Low a. An elevated hemoglobin. b. A decreased sedimentation rates. c. A decreased red cell distribution width. d. An elevated white blood cell count When teaching the leukemia patient and his family, which is the reason why the nurse stresses the importance of hand washing, reducing the number of visitors, and monitoring temperature? Low  a. High risk of cross-contamination  b. High risk for infection  c. Risk of poor hygiene  d. Risk of ineffective healing The patient is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? High  a. CLL is not serious, and patients die from other causes first.  b. There are no symptoms with this form of leukemia.  c. This patient had illness and is self-limiting.  d. In early stages of CLL, the patient may be asymptomatic. The nurse is assessing A patient diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? Low  a. Fever and infections.  b. Nausea and vomiting.  c. Excessive energy and high platelet count.  d. Cervical lymph node enlargement and positive acid-fast bacillus. What is leukemia?   A Infection of the red blood cells  B Rapid death of all blood cells  C Lack of red blood cells  D Cancer of the white blood cells The cause of leukemia is unknown, but risk factors include...  A Exposure to high amounts of radiation  B Exposure to chemicals such as benzene  C Genetic problems such as Down syndrome  D All of the above There are four main types of leukemia.   A True  B False Leukemia is the most common cancer in  children.  A True  B False Leukemia is more common in men than in women.  A True  B False It is possible to cure some types of leukemia in children.  A True  B False What is one of the newest forms of treatment for leukemia?  A Stem cell transplantation  B Chemotherapy  C Radiation therapy  D Surgery