Ward Class

An Online Resource Site For Student Nurses

Welcome

Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

Site Announcement

The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Hematologic Disorders: Leukemia

  • a malignant disease of blood-forming tissues, including the bone marrow and the lymphatic system
  • characterized by a proliferation of abnormal white blood cells that do not mature beyond the blast phase; these abnormal cells crowd out healthy RBCs, WBCs, and platelets leading to bone marrow depression
  • peak incidence is 3 to 5 years among children
  • accounts for 8% of all cancers and is the most common form of cancer in children and young adults
  • half of all leukemia cases are acute, with rapid onset and progression resulting in 100% mortality within days to months without approproate therapy
  • although the cause of leukemia is unknown, risk factors include genetic factors, exposure to ionizing radiation and chemicals, congenital anomalies such as Down's and Patau's syndrome, presence of primary immunodeficiency, and infection with the human T-cell leukemia virus type 1
  • types of leukemia:
  1. acute lymphoblastic leukemia (ALL)- the most common type of leukemia in children; acute onset; patients have a 95% chance of remission with treatment and a 75% chance of surviving 5 years or more
  2. acute non-lymphocytic leukemia (ANLL)- more common in adults (median age is 67 years); includes granulocytic and monocytic types; 60-80% of patients will obtain remission with treatment and cure rate is between 30-40%.
  3. chronic myelonous leukemia (CML)- 90% of patients have an abnormal chromosome called Philadelphia chromosome; clients go into a blast crisis and without treatment, patients die within six months of onset
  4. chronic lymphocytic leukemia (CLL)- more often seen in men older than 50 years of age; characterized by the proliferation of early B lymphocytes and is usually discovered though a complete blood count (CBC); this leukemia is of the indolent type and may take 15 years to progress
Assessment Findings
  • anemia, weakness, pallor, dyspnea
  • bleeding, petechiae, spontaneous bleeding, ecchymoses
  • frequent infection, fever, malaise
  • excessive sweating, esp. at night
  • enlarged lymph nodes, spleen, and liver (common in ALL than in ANLL)
  • abdominal plain with weight loss and loss of appetite
  • bone pain or tenderness
  • diagnostic findings:
  1. cbc- WBC count may be normal, abnormally low, or extremely high; platelet and hemoglobin are usually low
  2. bone marrow aspiration- key diagnostic tool; shows overall increase in the number of bone marrow cells with an increase in the proportion of earlier forms
Medical Management
  1. chemotherapy for acute leukemia- given to destroy malignant cells of the bone marrow; has three phases: induction (intense and potentially life-threatening), CNS prophylaxis (chemotherapy with radiation), and maintenance phase (chemotherapy lasting 2 to 3 years and commonly used in ALL)
  2. biological therapy (immunotherapy)-uses substances that bolster the immune system's response to cancer
  3. kinase inhibitor- effective in treating early stages of CML
  4. radiation therapy- X-rays or other high-energy rays are used to damage leukemic cells and stop their growth
Surgical Management
  1. bone marrow transplant- leukemic bone marrow is replaced with leukemia-free marrow; high doses of chemotherapy or radiation therapy is first used to destroy unhealthy bone marrow and then is replaced by bone marrow from a compatible donor
  2. stem cell transplant- similar to bone marrow transplant except the cells are collected from the stem cells that circulate in the peripheral blood; this process can be autologous or allogenic; used more often than bone marrow transplant

Nursing Management

  1. provide care for client receiving chemotherapy and radiation
  2. assess client for signs of infection and bleeding
  3. encourage increased nutritional intake; administer antiemetics as inidicated
  4. provide support for client and family
  5. support patient during painful procedures such as bone marrow aspirations and lumbar punctures
  6. allow patient as much control as possible esp. in food selection
  7. provide health teachings on infection control, bleeding precautions, rest and dietary requirements
Prognosis

The prognosis for the different types of leukemia varies widely. With treatment, younger patients have the best chances of survival if diagnosed early. Patients with chronic leukemia also live longer than those with acute forms of leukemia as the average survival rate of patients diagnosed with chronic leukemia is 9 years.

Prevention

There is no known way to prevent leukemia but risk factors may be reduced by avoiding exposure to high doses of radiation, benzene, alkylating agents used to treat other types of cancer, and cigarette and tobaco smoke.

Related Link:

Oncologic Nursing: Chemotherapy

3 comments:

  1. paulvr173cm said...
     

    Where do you get this info?

  2. Satria Sudeki said...
     

    hei... I read your information from begining to the end and I think that is interesting information.. I think i will tell this information again to my friend and I hope this information will be usefull for them... oh yes I suggest you to check my blog on www.leukemiasolution.blogspot.com , I hope the article on my blog will be usefull for you... and we can share each other. thank you... ;-)

  3. edmer khrysall diaz said...
     

    i really love this blogspot!..can I have a request?..can you post an article about pneumothorax? and also a case study about it. thnx...God bLess. :j

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