Bb Leukemia Fall12-1

8/22/2019 Bb Leukemia Fall12-1

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LEUKEMIA

Kimberly Ambruso, RN, MS NU 102

Fall 2012
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Malignancy: cells that grow and proliferate

in a disorderly or chaotic fashion

The cells have lost their ability to perform theirintended function

What is cancer?


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Adults vs. Kids

Embryonic

Rapid growth

Environmental

Radiation exposure(Carcinogens)

Other sources?

Genetic

Inherited: retinoblastoma Chromosomal:

Down syndrome

Impaired immunefunction

Viral infections

HIV Epstein Barr

Medications

Chemotherapy

Immunosuppressants

Presumed Causes
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Leukemia: most common in most age groups

Brain & CNS

Lymphomas: increases with age Bone/sarcoma: increases with age (teens)

Incidence of Pediatric Cancers


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General Symptoms

Bleeding and bruising

History of respiratory

infections Weakness, fatigue

Pain, tenderness, joint

swelling, decreased ROM,

unsteady gait

Abdomen: swelling, pain,

change in bowel pattern

Mass: may be palpable Neurological changes

Enlarged lymph nodes

Unexplained weight loss/

cachexia


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A group of disorders

characterized by the

uncontrolled proliferation

of abnormal immature

blood cells

Lymphoid or myeloid

Blast cells

Most common form ofchildhood cancer

More common in boys

TYPES

ALL- Acute Lymphoblastic

Leukemia

AML- Acute MyelogenousLeukemia

Chronic Leukemias- much

less common in children

CML

CLL

Leukemia


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Symptoms

Fever

Bleeding/bruising/

petechiae

Fatigue

Pallor

Bone pain

Recent infection

Hepato/spenomeg-aly

Treatment

Chemotherapy

CNS treatment

Chemo

radiation

Testicular radiation

Bone MarrowTransplant

Leukemia


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CBC with differential

WBC

Lymphocytes Neutrophils (Absolute

Neutrophil Count)

Platelets

Normal range?

Hgb/Hct Normal Hgb?

Normal Hct?

Biopsies

Lymph nodes

Testicles

Leukemia Diagnostics


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Bone Marrow Aspiration

Under

anesthesia/conscious

sedation Propofol (Diprivan) very

short acting

Pelvic bone- anterior or

superior iliac crest

10-14 g. needle

Lumbar Puncture

Detects presence of

cancer cells in CSF

Leukemia Diagnostics


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Cancer Chemotherapy

Attempts to kill rapid growing/abnormal cells

Kills normal (good) cells in the process

Cell-cycle specific Combinations are almost always used

Protocols

roadmaps

Based on research/evidence

May be institution specific or national protocols


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ALL

2-3 yrs

Bone marrow

Transplant (BMT) ifrelapse

AML

Intense therapy, 6months

BMT (if remission isachieved)

Pre-chemo

Hydration

Baseline CardiacFunction

Labs

CBC

Chemistry

Renal function

Chemotherapy for Leukemia


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Common side effects Nausea, vomiting, diarrhea

Alopecia

Neutropenia,. Thrombocytopenia,anemia

Mucositis

Renal, hepatic insufficiency

CVAD care

Types of access devices Routine nursing care

complications

Nursing Care-Chemotherapy


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Private room

No thin skinned fruits or

vegetables

No raw foods, fast foods

No flowers

No pets, goldfish

Screening of visitors

Dedicated stethoscope,

BP cuff, thermometer

Meticulous hygiene

Heavy duty cleaning at

home

Neutropenic precautions


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Nystatin

Peridex (chlorhexidine gluconate) or Biotene Miracle Mouithwash

PO fluid choices

NO OTC mouthwash

Mucositis


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CNS Below average academic

achievement/IQ

Visual spacial skills

Memory/attention Motor skills

Growth HormoneFailure

Sterility/reduction insperm/ovaryproduction

Cardiac

Left ventriculardysfunction

Hearing

Musculoskeletal

Avascular necrosis

osteoporosis

Dental Secondary cancers

Psychosocial

Long Term effects


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Replacement of diseased marrow with healthy

marrow

Leukemias, lymphomas Allogeneic Solid tumors, lymphomas Autologous

High doses of chemo and/or radiation

Transplant: resembles a blood transfusion Side effects: same as with chemotherapy, but

much more magnified

Bone Marrow Transplant


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Related to transplant

Graft vs. host disease

Attack on the new body

Graft failure

Own cells take over

Related to

immunosuppressant

therapy

Mood swings Hyperglycemia

Weight gain

Seizures Hirsutism

Body image

Bone Marrow Transplant

Side Effects

Bb Leukemia Fall12-1

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