Leukemia Theory Exam 5

�Disease of the blood and blood forming tissues

Leukemia

Where is leukemia found?

�Bone Marrow
�Lymph System
�Spleen

Acute or chronic - depending on age and maturity of cells
All age groups
-Lerukocell involved with leukemia?

Lymphocytic or Miologinisis

Problem with myloblasts or myeloid cells
(Immature granulocytes (Neutrophils, eosinophils and basophils )

Milogensis

Immature lymphocytes that invade bone marrow= what makes up the immune system= immunocompromised

Lymphocytic

�Mutation in DNA of cells
�Overproduction of immature "white" cells called blasts
�Nonfunctional

Patho of Leukemia

Has no function
Continue living when normal healthy cells die out

Blasts

�Leukemia cells do not attack normal cells but rather compete with them & crowd out healthy cells in bone marriw
�Depresses bone marrow production

Patho of Leukemia

Decreased bone marrow production?

Leukemia

A decreased bone marrow production= a patient will develop?

Anemia
Neutropenia
Thrombocytopenia
Invasion of bone marrow=Weakened bone

�decreased erythrocyte production

Anemia

�lack of healthy white blood cells
�Risk for infection

Neutropenia

decreased platelet production
�Risk for bleeding

�Thrombocytopenia=

�Invasion of bone marrow causes weakened bone=

Risk for fractures and bone pain

Presenting symptoms could be?

Bone pain and look at presenting signs and symptoms

Patient presentation for leukemia?

�Fever
�Pallor-Pale
�Fatigue
�Anorexia- no appetite
�Hemorrhage
�Petechiae
�Bone pain
�Joint Pain

Flat not raises
Bleeding due to thrombocytopenia

Petechiae

Possible organ involvement with leukemia because they can enlarge organs "Fibrosis of organ over time

�Hepatosplenomegaly
�Lymphadenopathy-less common
�CNS involvement can occur
�Kidneys
�Prostate
�Ovaries
�GI Tract
�Lungs

CNS involvement that can occur with leukemia?

�Pain & stiffness in neck
�Cranial nerve- Symptoms or damage "Facial nerve 7

Minegies become invaded with Leukemia cells and they don't allow normal flow of CSF

CNS involvement with Leukemia

Diagnosis of Leukemia?

�Through H&P
�Peripheral blood smear
�Bone Marrow Aspiration/Biopsy
�When diagnosis is confirmed LP performed to determine CNS involvement

Contains immature leukocytes

Peripheral Blood smear

This is to confirm leukemia and might see blasts here

Bone marrow aspiration/Biopsy

�Important to determine the type of leukemia

Lumbar puncture

�When diagnosis is confirmed _____ performed to determine CNS involvement or not

Lumbar Puncture

Different types of leukemia?

1. Acute Lymphoctic Leukemia
2. Acute Myelogenous Leukemia
3. Chronic Myelognenous Leukemia
4. Chronic Lymphocytic Leukemia

�Peak prevalence between 2-5 years
�Increases again after 50 years

Acute Lymphocytic Leukemia

Sudden onset, immature in nature
MOST COMMON FORM

Acute Lymphocytic Leukemia

�15-20% of leukemia in children
�80% adults Leukemia
�Increased incidence after 60 years of age

Acute Myelogenous Leukemia

More mature and gradual
�Increased incidence with advanced age
�Very rare in children

Chronic Myelogenous Leukemia

Genetic link is with what types of leukemia?

Chronic Myelogenous & Acute Lymphocytic Leukemia

This type involves Philadelphia Chromosome

Chronic Myelogenous Leukemia

Translocation of chromosome 9 & 22= interferes with normal cell perliferation

+ for Philadephia Chromosome

�Increased incidence with advanced age
�Men

Chronic Lymphocytic Leukemia

Treatment phases of leukemia?

1. Induction Phase
2. Intensification/Consolidation Phase
3. Maintenance Phase

Bone marrow suppression

Induction Phase

�Aggressive
�Begins after diagnosis lasting 4-5 weeks
�Corticosteroids
�Vincristine
�L-asparaginase

Induction Phase

To destroy all leukemic cells throughout body and to achieve remission
"Can become critically ill due to bone marrow suppression from chemo

Aggressive treatment from induction phase

May have to take prophalytic antibiotic to prevent pneumonia

Induction phase

�Doxorubicin
�Daunomycin
�Cytosine arabinoside
�Cytarabine
�Idarubicin

�AML-slightly different treatment than ALL
INDUCTION PHASE

�During the first 6 months of treatment
�Drug therapy depends on the type of leukemia

Intensification/Consolidation Phase

To destroy leukemia cells that aren't evident clinically

Intensification/Consolidation Phase

Keep body free of Leukemia Cells because its long

Maintenance Phase

�Drug regimen is based on leukemia type
�Monitor CBC

Maintenance Phase

This is usually not used in AML pt because its not as effective

Maintenance Phase

Every 3-4 weeks for longer time to preserve remission pt achieved

Maintenance Phase

Help interrupt cell growth @ multiple points throughout cell cycle

Multi agent Therapy (Maintenance Phase)

Could have 3 years of tx= living changing

ALL

�For high risk patients (all children) or patients with CNS involvement

Central Nervous System Prophalysis- Lumbar Puncture

Through lumbar puncture= CNS Studies= then administer through lumbar puncture procedure

Intrathecal Chemotherapy

Intrathecal Chemotherapy meds?

�Methotrexate
�Methotrexate, Cytarabine, Hydrocortisone combo

Greatly reduced SE of cranial spinal radiation= TERRIBLE LATE SE
Common in the 80's

Intracethcal Chemotherapy

Late SE of intrathecal chemotherapy?

Cognitive, learning, L&D, stunted growth

�Can be used in induction, intensification, or maintenance phase of treatment

�Central Nervous System Prophylaxis

Different treatments for leukemia?

�Central Nervous System Prophylaxis
-Reinduction after relapse
-Bone Marrow Transplant

�Evidence of relapse is leukemia cells in the bone marrow

Reinduction after relapse

Bone marrow transplant uses what cell?

Hematopoietic Stem Cell

�eliminate leukemia cells & hematopoietic stem cells with chemo or radiation. The stem cells are replaced through transplant

Hematopoietic Stem Cell

After therapy and will need additional

Bone marrow transplant

�matched sibling or volunteer donor

HLA match or Allogenous

Identical twin

syngeneic

Patients own harvested cells

Autologous

Risk for developing grath vs host disease and severe infection

Bone marrow transplant

Eliminate all leukemia cells: completely immunosuprresied
"Isolation, limited caregivers

Bone marrow transplant

�Children have greater than 80% survival rate with multiagent chemotherapy (Before pt's would only live 2-3 weeks)
�Adults-
�Depends on the type of leukemia
�Depends on other co-morbidities

Prognosis of Leukemia

�Supportive Interventions
�Myelosuppression
�Anemia
�Thrombocytopenia
�Neutropenia
�Monitor for drug toxicity
�Side effects of treatment regimen
�Emotional support
�Education
�Thorough assessment

Nursing care of Leukemia

Myelosuppression can cause?

Anemia
Thrombocytopenia
Neutropenia

Fatigue, skin color, vitals: Increased HR, Increased Oxygen, hemoglobin levels= decrease threshold for tranfusing

Anemia

8 is okay in cancer pt due to?

Decreased threshold for transfusing

Bleeding gums, soft bristle toothbrush, hazardous sports (contact, jumping off couch), bruising petiache

Thromboctyopenia

Risk for life threatening infection = no leukemia cells and healthy cells

Neutropenia

Avoid crowds, perform hand hygiene, oral care, decreased threshold fever ""100.4 or higher

Neutropenia

Neutopenic diet?

1. No fresh fruits or veggies - if peel that's fine
2. No raw meats
3. No sushi or oysters due to bacteria
4. No unpasteurized milk
5. No apple cider
6. No fresh flowers

Side Effects of Chemo Normal

Hyperuricemia
Cardiotoxicity
Pericarditis and myocarditis
Fatigue
Anorexia
Constipation
Diarrhea
Hepatotoxicity
N&V
Stomatitis, Mucositis, and Esophagitis
Hemorrhagic Cystitis
Nephrotoxicity
Reproductive Problems
Anemia
Leukopenia
Thrombocytopenia
Alopeci

Relys on others to care for them, may have to quit job, teach about resources available "St. Jude

Emotional Support with Leukemia

New dx= overwhelming= use teach back method= check in frequently

Education with Leukemia

To know exactly whats going on
-Mouth sores= goes to entire GI tract= talk and develop repport to help
Ex: sores on butt could be a sign of infection

Thorough Assessment

Immunizations to get with leukemia?

Flu and pnemococcial

Make sure they havent had fever or ill

Immunizations and Leukemia

Body won't produce normal immune response
-Wait until after tx and then get them on a "catch up schedule

Regular scheduled immunizations