Leukemias

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Before we start, remember that cancer is confirmed with biopsies. Look at the actual cancer cells.

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Lymphocytic: involves abnormal cells from the lymphoid pathways
Myelogenous: involves abnormal cells from myeloid pathways
Affects bone marrow causing: anemia, leukopenia, and thrombocytopenia.
Risk factors: viral, genetic, enviornment and exposure to chemicals, radiation, medications.

The big leukemia/cancer symptoms

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Acute Non-Lymphocytic Leukemia (ANL) or AML

Chronic Myeloid Leukemia (CML)

Usually 55 to 60 years of age. Very uncommon in people under 20
Prognosis 3 to 5 years
Uncontrolled proliferation of myeloid cells
Stages: chronic, accelerated, and blast
Symptoms: hepatomegaly, splenomegaly, anorexia, weight loss. May be asymptomatic at first.
Confusion/SOB due to WBC >100,000: Treat emergently
Management: Imatinif mesylate (Gleevec), chemotherapy, bone marrow transplant, & stem cell transplant

Acute Lymphocytic Leukemia (ALL)

Chronic Lymphocytic Leukemia (CLL)

Most common malignancy of older adults.
Malignancy of activated or mature B lymphocytes
In the early stages it is often just monitored
Some clients may be asymptomatic. Treatment is mainly chemotherapy, but also monoclonal antibodies.

Remember!

ALL or Acute Lymphocytic Leukemia is the leukemia of Children
and CLL Chronic Lymphocytic Leukemia is the leukemia of older people.

Leukemia Symptoms

Anorexia, weight loss, weakness
Bleeding: nose bleeds, hematuria, occult bleeding, ⇑ menstrual bleeding, ecchymosis, petechiae
Fever, enlarged nodes, hepatomegaly, splenomegaly
Tachycardia, SOB
Bone pain
Anemia, thrombocytopenia, changes in WBC (either high or low, sometimes normal)

Nursing Interventions: Infection

Infection is the major cause of death
Monitor closely
Use protective isolation
Handwashing
Avoid sick visitors
Strict aseptic technique
Private room with door closed
No fresh foods, no flowers, plants
Good environmental cleaning
Antimicrobial soap to bathe
Prevent constipation
Assess wounds/mucous membranes/lungs/vital signs/sputum/urine for infection
Avoid crowds
No Live virus vaccines for client and family.
Low bacteria diet. No fresh fruits and vegetables.
Send cultures and give antibiotics as ordered.

Nursing Interventions: Bleeding

Remember thrombocytopenia
< 50,000 risk for bleeding
< 20,000 risk for spontaneous bleeding; may need transfusion
Handle client gently
Monitor for internal bleeding: abdominal distension, increased girth, tachycardia
Avoid injections
Apply pressure for at least 5 minutes after needle sticks
Avoid rectal suppositories, enemas, and rectal thermometers
Watch for excessive menstrual bleeding
Electric razors
Avoid NSAIDs and aspirin
Restrict activity to prevent falls. Bedrest
Use soft toothbrush

Fatigue and Nutrition

Well-balanced diet
Small frequent meals w/high calories, high protein, high carbs
Food easy to chew to reduce energy used to eat
Help client in self-care
Adequate rest periods and naps
Encourage fluid intake 3-4 L/day
Analgesics: Tylenol is best

Treatment of Neutropenia

Filgrastim (Neupogen) is given to increase the absolute neutrophic count or treat neutropenia.
It is stopped when ANC is > 1000 cells/mm3.
It is a granulocyte colony stimulating factor or (G-CSF)
Side effects: bone pain, fever, diarrhea, weakness, and rash.