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Lincoln Memorial University

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leukemia hematologic neoplasms medical management health care

Summary

This document provides an overview of leukemia management, specifically focusing on Acute Myeloid Leukemia (AML) and Chronic Myeloid Leukemia (CML). It covers various aspects, including symptoms, treatment approaches, complications, and nursing considerations. The information is presented in a chapter format.

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**Chapter 30: Management of Patients with Hematologic Neoplasms** **Leukemia,** pg 2607 figure 30-1 - **Acute Myeloid Leukemia (AML)**, pg 2609 - Acute myeloid leukemia (AML) originates due to a series of genetic mutations in the myeloid HSC leading to clonal development o...

**Chapter 30: Management of Patients with Hematologic Neoplasms** **Leukemia,** pg 2607 figure 30-1 - **Acute Myeloid Leukemia (AML)**, pg 2609 - Acute myeloid leukemia (AML) originates due to a series of genetic mutations in the myeloid HSC leading to clonal development of abnormal blast cells - AML affects the blood and bone marrow. It is characterized by the rapid proliferation of abnormal myeloid cells, which are a type of WBC that normally help fight infection - **As these blast cells (immature leukocytes) continue to proliferate, they crowd out the normal bone marrow production leading to anemia, thrombocytopenic and either low or elevated WBC counts** - Patho: Defect in stem cell that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, & platelets i. Most common is nonlymphocytic leukemia - Prognosis highly variable - Symptoms from abnormal blood cell counts ii. s/s: fever, weight loss, neutropenia, petechiae, weakness, fatigue, bleeding tendencies, pain from enlarged liver or spleen, hyperplasia/overgrowth of gums, & bone pain - Labs: CBC and bone marrow analysis (which shows an excess number of blast cells) - **Tx: Induction, consolidation, supportive therapies, aggressive chemotherapy, hematopoietic stem cell transplantation (HSCT)** iii. Supportive care may be the only option, antimicrobial therapy & transfusion, death occurs w/in months - Complications: bleeding and infection (which are the major causes of death in these pts) - **Chronic Myeloid Leukemia (CML)** pg. 2617 - Patho: Mutation in myeloid stem cell w/ uncontrolled proliferation of cells (Philadelphia chromosome) - CML affects the blood and bone marrow. It is characterized by the rapid proliferation of abnormal myeloid cells, which are a type of WBC that normally help fight infection but unlike AML, CML progresses more slowly and is divided into three stages iv. Stages: 1. Chronic phase: few s/s & not be affected by disease 2. Transformational phase: slow or very rapid; marks evolution into acute stage 3. Blast crisis: most advanced; show s/s of acute myeloid then chronic - S/sx: weight loss, malaise, confusion or shortness of breath, enlarged/tender spleen or enlarged liver - **Medical management:** v. Goal is to keep dz in acute remission or keeping pt in chronic phase for as long as possible vi. Oral tyrosine kinase inhibitors (TKIs): the use of tyrosine kinase inhibitors (TKIs) has significantly improved treatment and long-term survival for patients with CML - **Nursing management**: it is extremely important for the nurse to educate the patient about the medication regimen, how to manage side effects, drug interactions, and safe handling - **Treatment: imatinib mesylate (Gleevec)** which blocks signals in leukemic cells that express BCR-ABL protein, chemo & HSCT - **Acute Lymphocytic Leukemia (ALL)** - Uncontrolled proliferation of immature cells/lymphoblasts from lymphoid stem cell - Most common in young children, boys more often than girls, & peaks @ 4 years old - Prognosis is good for children; 85% for 3-year event-free survival but drops w/ increased age \< 45% adults - **S/sx:** anemia, pallor, fatigue, weakness, DOE, pain from enlarged liver/spleen, dizziness, petechiae, ecchymosis, lymphadenopathy, and splenomegaly is rare - Tx: chemotherapy, HSCT, monoclonal antibody therapy, corticosteroids - **Chronic Lymphocytic Leukemia (CLL) (MC leukemia in adults) "A-accumulation, B-symptoms, C-chronic"** - **Patho: Accumulation of abnormal B lymphocytes in the bone, blood, and lymph nodes** - **Slow progression** - **KNOW Chart 30-1 risk factors:** vii. - - - - - - - Tx varies depending on pt and stage viii. Early: watch weight ix. Late: IVIG, chemo agents, HSCT **Nursing Process for Acute Leukemia** - Assessment: family hx, weight loss, bleeding, loss of appetite - Interventions: Managing infection and bleeding - Managing mucositis x. Artificial saliva, mouth moisturizer - Improving nutritional intake. Easing pain - Labs: cultures as needed before antibiotics - Interventions - Decreasing fatigue and activity intolerance. Maintaining F&E balance - Improving self-care. Managing anxiety and grief. Encourage spiritual well-being **Malignant lymphomas:** **Hodgkin's Lymphoma pg. 2656** - - - xi. Stage 1: localized, single lymph node region xii. Stage 2: 2 or more lymph node regions on same side of diaphragm xiii. Stage 3: 2 or more lymph node regions above & below diaphragm xiv. Stage 4: widespread dz; multiple organs w/ or w/out lymph node involvement - - - - - - - xv. Lymphadenopathy and B symptoms, weight loss, fatigue, weakness, fever - - - xvi. It is extremely important for the nurse to know the specific disease type, stage of disease, treatment history, and current treatment plan - - Pancytopenia w/ radiation therapy and/or chemo - N/V w/ RT and/or chemo. Skin problems w/ RT - Constipation or diarrhea w/ RT adn/or chemo - Impaired liver function w/ mets - Sterility for males - Secondary cancer development **Multiple Myeloma** - - - - xvii. Age: rarely occurs in those less than 35 years of age; risks increase with increasing age xviii. African Americans have twice the risk of Whites xix. Exposure to radiation, petroleum products, benzenes, and Agent Orange xx. Family history, particularly among first-degree relatives (e.g., siblings, parents) xxi. Men have slightly higher risks than women xxii. Overweight or obesity - xxiii. **HyperCalcemia (\>11.5 mg/dL):** (which can cause Thirst, Constipation, Confusion and can lead to coma) xxiv. **Renal insufficiency** (creatinine \>2 mg/dL or creatinine clearance of less than 40 mL/min) xxv. **Anemia** (hemoglobin less than 10 g/dL or 2 g/dL less than normal) xxvi. The presence of **Bony lesions/bone destruction**. xxvii. Other s/s: Bone pain, Spinal fractures/compression, Leukopenia, Thrombocytopenia, Kidney Damage, death xxviii. **Nursing note: Any older adult whose chief complaint is back pain and who has an elevated total protein level should be evaluated for possible multiple myeloma.** - - - - - -

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