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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
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