Leukemia

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

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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 leukemiaAcute 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 leukemiaAcute myelogenous leukemia
  (AML) 20 survival rate
• Chronic myelogenous leukemia (CML)

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Leukemia Etiology

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

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Leukemia Sx-

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

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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

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Nursing Management

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

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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

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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.

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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

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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

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Non-Hodgkins Lymphomas

• Patho
• Prevalence
• Categories
• Low grade (indolent)
• Intermediate grade (aggressive)
• High grade (very aggressive)
• Affects all ages
• Manifestations

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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

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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

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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