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Leukemia

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Leukemia & Lymphoma Keith Rischer, RN, MA, CEN Leukemia Patho Loss of regulation in cell division, causes proliferation of malignant leukocytes Classification based ... – PowerPoint PPT presentation

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Title: Leukemia


1
  • Leukemia
  • Lymphoma
  • Keith Rischer, RN, MA, CEN

2
Leukemia
  • Patho
  • Loss of regulation in cell division, causes
    proliferation of malignant leukocytes
  • Classification based on predominant cell of
    origin
  • Lymphoid
  • Myeloid
  • Acute or Chronic
  • Lymphocytic leukemia Acute lymphocytic leukemia
    (ALL)most common w/peds
  • 5 yr survival 80 peds/40 w/adults
  • Chronic lymphocytic leukemia (CLL)-most common
    w/adults
  • 73 survival rate
  • Myelogenous leukemia Acute myelogenous leukemia
    (AML) 20 survival rate
  • Chronic myelogenous leukemia (CML)

3
Leukemia Etiology
  • Chromosomal changes
  • Chemical Agents-Benzene
  • Chemotherapy-Alkylating Agents
  • Viruses-Retroviruses
  • Radiation
  • Unknown factors

4
Leukemia Sx-
  • Clinical Manifestations
  • Anemia
  • Fatigue and weakness
  • Bleeding
  • Fever and Infections
  • Weight loss-joint pain
  • Mouth sores
  • Hepatosplenomegaly Lymphadenopathy
  • Diagnosis

5
General Treatment of Leukemia
  • Chemotherapy
  • Induction therapy- attempts to induce or bring
    about remission.
  • Consolidation therapy - after remission
    achieved-eliminate remaining cells
  • Maintenance therapy- treatment with lower doses
    of same drugs every 3-4 weeks
  • Combination therapy
  • Stem cell transplant
  • Bone marrow transplant

6
Nursing Management
  • Acute
  • Many emotional-psychosocial needs/support
  • Communicate tx plan-expected course
  • Protective Isolation/Neutropenic Precautions
  • Educate!!
  • Chemo-manage side effects
  • Spiritual care

7
Neutropenia
  • Severe decrease in neutrophils-secondary to chemo
    or immunosuppressive therapy
  • Sx decreased immune/inflammatory response-masks
    infectionlow grade fever significant gt100.4
  • Nursing Management
  • Neutropenic precautions
  • obtain pan cultures
  • start IV abx
  • assess for septic shock

8
Lymph System
  • Consists of lymphatic capillaries, ducts, lymph
    nodes, lymph fluid
  • Function
  • Returns excess interstitial fluid to the blood
  • Absorbs fatty acids
  • Produces immune cells
  • Lymph nodes Filtration of bacteria and foreign
    particles carried by lymph fluid.

9
Lymphoma Hodgkins
  • Patho
  • Incidence
  • Clinical Manifestations
  • Enlargement of cervical, axillary or inguinal
    lymph nodes
  • Wt Loss, Fever and chills,Night sweats
  • (these correlate with a worse prognosis, B sxs)
  • - Fatigue and weakness
  • Tachycardia
  • Diagnosis

10
Lymphoma Hodgkins
  • Treatment Based on stage of the disease
  • Radiation alone or with chemotherapy
  • Objective
  • least amt of tx to achieve cure yet minimize
    short-term long-term complications
  • Nursing Management
  • pain control
  • managing side effects
  • psychosocial support

11
Non-Hodgkins Lymphomas
  • Patho
  • Prevalence
  • Categories
  • Low grade (indolent)
  • Intermediate grade (aggressive)
  • High grade (very aggressive)
  • Affects all ages
  • Manifestations

12
Non-Hodgkins lymphomas
  • Diagnosis
  • Treatment
  • Radiation if just stage I
  • Chemotherapy involves multidose/multiagent
    regimen
  • Holistic nursing management-same as previous
    blood disorderspain control, management of SE,
    psychosocial support,
  • Spiritual care-multidisciplinary team

13
Multiple Myeloma
  • Patho
  • excess production of plasma cells w/resultant
    myeloma proteins destroys bone/bone marrow
  • Incidence
  • Clinical manifestations (develop slowly and
    insidiously)
  • Skeletal pain (esp pelvis, spine ribs) Major
    manifestation, presents first.
  • Osteolytic lesions can see in skull, vertebrae
    ribs
  • Hypercalcemia from bony degeneration
  • Anemia, thrombocytopenia, granulocytopenia

14
Multiple Myeloma
  • Diagnosis
  • Lab, x-rays, bone marrow
  • Urine has Bence Jones protein
  • Collaborative management
  • Radiation
  • Chemo
  • Nursing Management
  • Ambulation adequate hydration
  • Ambulate w/care
  • Pain control
  • Infection control
  • Emotional/spiritual support
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