Leukaemia 2024.pdf

Medical Nursing I – SSN 280 E. A. Boateng Department of Nursing, KNUST [email protected]  Introduction  Abnormal overproduction of leukocytes, usually at an immature stage, usually at an immature stage, in the bone marrow  Proliferating immature WBCs (blast cel...

Medical Nursing I – SSN 280 E. A. Boateng Department of Nursing, KNUST [email protected]  Introduction  Abnormal overproduction of leukocytes, usually at an immature stage, usually at an immature stage, in the bone marrow  Proliferating immature WBCs (blast cells) depress the bone marrow  Characterised by  Replacement of bone marrow by malignant immature WBCs  Abnormal immature circulating WBCs  Infiltration of liver, spleen, lymph nodes & other organs 29/05/2024 14:17  Introduction  Anaemia results from decreased erythrocytes, infection from neutropenia, and bleeding from thrombocytopaenia  Cause mostly unknown; may involve genetic damage of cells, leading to the transformation of cells from a normal state to a malignant state  Risk factors include genetic (down syndrome), viral (HTLV- 1), immunological (history of aggressive chemotherapy), and environmental factors and exposure to ionizing radiation, chemicals (benzene), and medications 29/05/2024 14:39  Cell Type Major Function WBC (Leukocyte) Fights infection Neutrophil Essential in preventing or limiting bacterial infection via phagocytosis Monocyte Enters tissue as macrophage; highly phagocytic, especially against fungus; immune surveillance Eosinophil Involved in allergic reactions (neutralises histamine); digests foreign proteins Basophil Contains histamine; integral part of hypersensitivity reactions Lymphocyte Integral component of immune system T lymphocyte Responsible for cell-mediated immunity; recognises material as “foreign” (surveillance system) B lymphocyte Responsible for humoral immunity; many mature into plasma cells to form antibodies Plasma cell Secretes immunoglobulin (Ig, antibody); most mature form of B lymphocyte RBC (Erythrocyte) Carries haemoglobin to provide oxygen to tissues; average life span is 120 days Platelet Fragment of megakaryocyte; provides basis for coagulation to (Thrombocyte) occur; maintains haemostasis; average life span is 10 days 29/05/2024 14:17  Classification  Based on acuity & predominant cell type involved  Acute Leukaemias: acute onset, quick progression, immature/undifferentiated blast cells, death within weeks without treatment  Chronic Leukaemias: gradual onset, slow progression, leukocytes mostly mature; usually better prognosis  Lymphocytic/Lymphoblastic Leukaemias: involve immature lymphocytes & their precursors in the bone marrow  Myelocytic/Myeloblastic Leukaemias: involve myeloid stem cells, affects maturation of other blood cells  4 types: acute myeloblastic, chronic myelocytic, acute lymphoblastic & chronic lymphocytic leukaemias29/05/2024 14:17 Acute Myeloblastic Leukaemia (AML)  Characterised by uncontrolled proliferation of myeloblasts (precursor for granulocytes) & hyperplasia of the bone marrow & spleen  Manifestation due to neutropaenia & thrombocytopaenia; fever, infection, epistaxis (nosebleed), haematuria, GI bleeding; anaemia (late manifestation), fatigue; pain (enlarged liver or spleen), bone pain (expansion of marrow), weight loss, night sweats, heat intolerance (due to rapid proliferation & hypermetabolism of leukaemic cells)  Bone marrow aspiration shows excess of immature blast cells; FBC reveals thrombocytopaenia & normocytic, normochromic anaemia  Death mainly due to bleeding & infection; usually 5yrs, may be more in the young 29/05/2024 14:17 Chronic Myelocytic Leukaemia (CML)  Due to a mutation in the myeloid stem cell; leads to a pathologic increase in the production of blast cells  Usually associated with chromosomal abnormality (Philadelphia chromosome) translocation, t(9;22)  3 stages: chronic, transformation, terminal blast crisis phase  Usually asymptomatic; malaise, anorexia, fatigue; splenomegaly, bleeding tendencies; infiltration of skin, lymph nodes, bones & CNS 29/05/2024 14:17 Acute Lymphoblastic Leukaemia (ALL)  Uncontrolled proliferation of precursor B (pre-B) or T (pre-T) lymphocytes – lymphoblasts; mostly pre-B; common in children  Manifestations mainly due to thrombocytopaenia, leukopaenia & anaemia; infiltration of spleen & liver causes pain, CNS causes headaches, vomiting, visual disturbances, seizures 29/05/2024 14:17 Chronic Lymphocytic Leukaemia (CLL)  Characterised by proliferation & accumulation of small, abnormal, mature lymphocytes in the bone marrow, peripheral blood, & body tissues  Usually involves B lymphocytes  Manifestations include malaise, anaemia, infections, fever, night sweats, abdominal pain, weight loss, enlarged lymph nodes, spleen & liver 29/05/2024 14:17 Acute Lymphoblastic Leukaemia Mostly lymphoblasts present in bone marrow Age of onset is younger than 15 years Acute Myeloblastic Leukaemia Mostly myeloblasts present in bone marrow Age of onset is between 15 and 39 years Chronic Myelocytic Leukaemia Mostly granulocytes present in bone marrow Age of onset is in the fourth decade Chronic Lymphocytic Leukaemia Mostly lymphocytes present in bone marrow Age of onset is after 50 years Diagnostic Investigations  Full blood count; leukocyte count may be normal but percentage of normal cells usually decreased; RBC & platelet count may be low, especially for acute types  Bone marrow aspiration/biopsy – biopsy to determine molecular characteristics of leukaemia, degree of bone marrow involvement, morphology and histology of the disease  Lumbar puncture to determine CNS involvement (mostly for ALL) Treatment  Involves chemotherapy and possibly radiation and hematopoietic stem cell transplantation  The phases of chemotherapy include  Induction, which achieves a complete remission or disappearance of leukaemic cells  Intensification or consolidation therapy, which decreases the tumour burden further  Central nervous system prophylactic therapy, which prevents leukaemic cells from invading the central nervous system  Maintenance, which serves to maintain the remission phase  Nursing Diagnoses  Risk for infection  Acute pain related to leukocyte infiltration of systemic tissues, fever, and infection  Hyperthermia related to infection  Imbalanced nutrition, less than body requirements, related to anorexia, pain, and nausea  Impaired physical mobility related to protective isolation  Disturbed body image related to change in appearance, function, and roles  Grieving related to anticipatory loss and altered role functioning 29/05/2024 14:17 Nursing Management  Prevention & management of infection & bleeding  Effective pain management  Nutrition: increased metabolic rate coupled with decreased nutritional intake due to pain; food should be soft, warm, small but frequent; low microbial diets (mostly uncooked fruits & vegetables); weight monitoring; fluids (particularly because of fever, bleeding, diarrhoea, vomiting)  Adequate physical activity/exercise; improving self-care; psychological care (management of anxiety & grief) 29/05/2024 14:17 Prevent Complications  Lubricate lips with water-soluble  Avoid aspirin and aspirin-containing lubricant every 2 hr while awake. medications or other medications  Avoid suctioning if at all possible; if known to inhibit platelet function, if unavoidable, use only gentle suctioning. possible.  Discourage vigorous coughing or  Do not give intramuscular injections. blowing of the nose.  Do not insert indwelling catheters.  Use only electric razor for shaving.  Take no rectal temperatures; do not  Pad side rails as needed. give suppositories, enemas.  Prevent falls by ambulating with patient  Use stool softeners, oral laxatives to as necessary. prevent constipation. Control Bleeding  Use smallest possible needles when  Apply direct pressure. performing venipuncture.  For epistaxis, position patient in high  Apply pressure to venipuncture sites for Fowler's position; apply ice pack to back 5 min or until bleeding has stopped. of neck and direct pressure to nose.  Permit no flossing of teeth and no  Notify physician for prolonged bleeding commercial mouthwashes. (eg, unable to stop within 10 min).  Use only soft-bristled toothbrush for  Administer platelets, fresh frozen mouth care. plasma, packed red blood cells, as prescribed The nurse, establishing a plan of care for a client newly diagnosed with leukaemia, designates which of the following as the priority nursing diagnosis? A. Knowledge deficit B. Risk for infection C. Anticipatory grieving D. Imbalanced nutrition: less than body requirement 29/05/2024 14:17 Which of the under-mentioned is NOT a necessary investigation for the diagnosis of chronic myelocytic leukaemia? A. Blood culture B. Differential count C. Bone marrow aspiration D. White blood count 29/05/2024 14:17