Leukemia

Patho

Decrease in mature WBCs RT overproduction of immature WBCs(usually blasts) in the marrow.

50% RT abnormal chromosomes

Other risk factors include environmental factors and exposure to chemicals, drugs, and radiation

Clinical Manifestations

Cardiac-decreased tissue perfusion, increased HR, decreased BP

Abnormal blood flow, abnormal heart sounds, murmurs, bruit

Respiratory-anemia RT decreased tissue perfusion. As anemia becomes severe, respiratory rate increases.

Skin-pallor around mouth and nail beds, cool skin-RT decrease in tissue perfusion

Increased bleeding, decreased platelets causing petechiae

Intestines-increased bleeding

Fatigue, weight loss, anorexia, nausea, decreased bowel sounds, constipation

Drug Therapy

Induction, consolidation, and maintenance therapy

Gleevac for chronic myelogenous leukemia

Stem cell transplant

Halt infections

Nursing Diagnosis

Risk for infection RT decreased immune response

Risk for injury RT thrombocytopenia

Fatigue RT decreased tissue perfusion

Hemophilia

Patho

Clotting factor deficiency/unable to form fibrin

Genetic X-linked recessive trait

A-deficiency of factor 8

B-deficiency of factor 9

Clinical Manifestations

Excessive uncontrolled bleeding/especially nose bleeding

Easily bruise

Joint and muscle hemorrhage

Decreased joint function

Surgical complications

Prolonged PTT, Normal PT, Normal bleed time

Interventions

Cryoprecipitate-factor 8 infusion

Monitor vitals

Apply cold compresses and pressure to bleeding

Prevent injury

Nursing Diagnosis

Risk for injury RT uncontrolled bleeding

Non-Hodgkins Lyphoma

Patho

Abnormal growth of lymphocytes

Occurs in lymphoid tissue-spleen and nodes

Associated w/ autoimmune d/o immune suppression

h-pylori and EBV increase risk

Clinical manifestations

Less orderly

Fever, night sweats, weight loss greater than 10 lbs.

Negative Reed Sternberg test, lympadenopathy

Nodal involvement, painless swelling of nodes

Diagnosed by biopsy of the node

Increase in LDH measures tumor growth rate

Staging based on cytology-amount of cell involvement

Classification based on class system-10 or 7 cell involvement-90% 10, 10% 7 cell

Interventions

Chemo drugs alone or with monodonal antibodies

Localized radiation therapy

Hematopoietic stem cell transplant

Vaccine therapy

Manage side effects of therapy

Nursing Diagnosis

Risk for infection RT pancytopenia

Impaired nutrition RT nausea and vomiting

Hodgkins Lymphoma

Patho

Viral infection EBV, HTLV, HIV

Starts at single node and progresses orderly

Positive marker for Reed Sternberg Test

Clinical manifestations

Large painless nodes that alcohol makes painful

Fever less than 101.5, night sweats, weight loss

Node biopsy for Reed Sternberg

CBC-decreased CBC

Electrolyte panel, Renal and liver function tests, Increased ESR, Bone marrow aspiration, CT, PET

Interventions

Radiation of lymph nodes

Alkylating chemo drugs

Monitor anemia, leucopenia, N/V, skin, liver

Monitor for secondary cancer development

Nursing Diagnosis

Risk for infection RT leucopenia

Impaired skin integrity RT radiation

Imbalanced nutrition RT cancer growth

Dehydration RT disease process AEB night sweats

Risk for bleeding RT decreased marrow production

Bone Cancer

Can be primary or secondary without a cause

Increased ESR and ALP as body attempts to form new bone and osteoblastic activity increases

Medications

Analgesics-pain

Chemo-cytotoxic drugs

Estrogen/progesterone blocking-if spread from breast cancer

Cytokines-to stimulate immune system

Zometa and Aredia-IV bisphosphonates help protect bones and prevent fractures

Radiation-mainly for Ewings

Interventions

Palliative care, padding, bracing, immobilization

Surgery

Wide resectioning-muscle/bone with two clean margins

Radical resectioning-amputation

Cryosurgery-cold application to reduce pain and tumor size

Nursing Diagnosis

Acute pain RT physical injury

Grieving RT change in body image

Ineffective coping RT decreased confidence

Imbalanced nutrition less than body requirements RT increased metabolic process

Osteosarcoma Ewing’s Sarcoma Chondrosarcoma Fibrosarcoma- Most common

primary- 50% in distal

femur, proximal tibia, humerus

- Large- Acute pain,

swelling RT large tumor size

- Warm, blood flow

- Increased osteoblastic activity

- Sclerotic center- Periphery is soft- Metastasizes

within 2 years to lungs=death

- Older w/paget’s increases risk

- More common in males

- Most malignant

- Pain, swelling- Systemic-low

grade fever, leukocytosis, anemia, lesions

- Pelvis and lower extremities most common

- Pelvis=poor prognosis

- Die if metastasizes to lungs or other bones

- Any age, children, young adults

- More in men- Sensitive to

cytotoxic drugs- Fatigue, pallor,

anemia

- Dull pain, swelling for a long period

- Pelvis, femur near diaphysis in proximal

- Destroys bone, calcifies

- Middle age and older adults

- Starts in cartilage tissue

- Palpable mass- Resistant to

drugs

- Malignant fibrous histocytoma

- Most malignant subtype

- Gradual w/o specific symptoms

- Local tendons with or without mass

- Long bones, lower extremity

- Middle age men

- Metastic greatly outnumbers primary

- Breast, prostate, kidney, thyroid, lung

Vitamin B12 Deficiency

Patho

Decrease in vitamin b12=decrease in folic acid into cell

This is where DNA synthesis occurs so RBCs are decreased=Anemia

Clinical Manifestations

Develops slowly

Pallor, jaundice, glossitis, fatigue, weight loss, paresthesias in hands and feet, Poor balance

Decrease RBCs, Hgb, and Hct

Shillings Test-tests for pernicious anemia

Interventions

Increase animal protein, eggs, nuts, dairy, dried beans, citrus fruits, green leafy vegetables

Only use vitamins in severe anemia

Drug-Calomist

Provide frequent rest periods

Nursing Diagnosis

Imbalanced nutrition RT decreased intake

Altered body image

Fatigue

Risk for injury

Amputations

An elective or traumatic event

Clinical Manifestations

Assess neuro status in affected extremity

Check circulation

Assess skin color, temperature, sensation, and pulses

Capillary refill

Observe and document any discoloration, edema, ulcerations, necrosis, and hair distribution

Assess for body image and self esteem

ABIs, Doppler Ultrasonography, Laser Doppler Flometry

Complications

Hemorrhage, infection

Phantom pain

Neuroma

Flexion contractures

Interventions

Assess for tissue perfusion

Management of pain

Antibiotics before surgery to prevent infection and monitor for infection after

Drugs: Miacalcin, Calcimar, Betablockers, Anticonvulsant, Antispasmadic

Promote ambulation and exercise

Promotion of positive body image

Prosthesis

Lifestyle adaptations

Polycythemia Vera

Patho

Cancer of RBCs, platelet impairment, abnormal and large RBCs

Clinical manifestations

Increased hemoglobin

Increased RBC

Increased Hct, leukocytes, and platelets

Darkening and flushing of facial skin

Hypertension, hypoxia, Gout, Hyperkalemia

Bleeding problems

Thrombosis

Increased size of RBCs

Interventions

Anticoagulants

Hydroxyurea- po chemotherapy drug

Increase fluids, avoid tight clothing, elevate feet

Phlebotomy-blood letting

Nursing Diagnosis

Risk for injury

Increased fluid volume

Impaired gas exchange

Decreased Tissue Perfusion

Osteoporosis

Patho

Chronic, metabolic disease

Osteoclastic activity exceeds osteoblastic activity

Decreased bone mineral density

Primary

Post-menopausal women, decreased testosterone, decreased calcium absorption

Secondary

Diseases-hyperparathyroid, long term drug use, prolonged immobility

Clinical manifestations

Kyphosis, back pain with activity, loss of height, joint pain and weakness

Fracture of wrist and hip

Depression, loss of independence, loss of ability to do ADLs

Fear of falling, lack of social interaction

Dual xray, absortiometry, qualitative ultrasound

Interventions

Low doses of hormones for short period of time

Parathyroid hormone, estrogen

Calcium and vitamin D

Nursing Diagnosis

Risk for fall

Impaired mobility

Acute Pain

Fractures

Disruption or break in the continuity of a bone

Cast care Traction Crutches Handle wet cast with

palms of hands Turn every 2 hours and

allow cast to dry Assess distal pulses Inspect for drainage,

odor, or cracking Check to make sure

cast is not too tight Circle and date

drainage on cast Create window to

drain

Maintain balance Weights should hang

freely Do not move weights Inspect skin around

pin sites Assess skin integrity

Placement should be 2-3 fingerwidths below axilla

Walkers and canes preferred for older adults

Lead with strong food Elbow flexed no more

than 30 degrees

Nursing diagnosis

Acute pain

Risk for infection

Impaired mobility

Hip Fracture

Patho

Osteoporosis is the biggest risk factor-bone weakness, breaks, falls

Compartment syndrome-reduction of circulation RT increased pressure in affected area

Crush syndrome-systemic complications result from hemorrhage and edema, causing ischemic and necrosis

Hypovolemic shock-losing too much fluid too fast, causing increased HR decreased BP, all fluid to reach core

Fat embolism syndrome-from yellow bone marrow, fat globules released into blood stream

Venous thromboembolism-caused from clot released into blood stream-VET and DVT

Infection-defense system is interrupted from injury, bone infection, MRSA

Ischemic Necrosis-blood supply is disrupted, leading cause of done tissue death

Clinical Manifestations

Pain-possibly in groin or behind knee

Check for other injuries, bone alignement, turning

Bruising, swelling, crepitus

Fear

***unable to bear weight