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M6 13-005

Exam 14: D/O of Leukocytes & Plasma

Agranulocytosis: broken down Without-granulocytes-state of disease
Agranulocytosis Potentially fatal condition of the blood, characterized by a severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils).
Leukopenia The white blood count is low
neutropenia absolute neutrophil count
Suppression of the bone marrow reduces the production of white blood cells
Agranulocytosis: Causes (a) Adverse medication reaction or toxicity. (b) Neoplastic disease. (c) Chemotherapy and radiation therapy. (d) Viral and bacterial infections. (e) Heredity.
Agranulocytosis: Clinical Manifestations (1) Fever and chills. (2) Headache and fatigue. (3) Ulcerations of mucous membranes (mouth, nose, pharynx, vagina, and rectum). (4) Bronchial pneumonia and urinary tract infections - occur in later stages.
Agranulocytosis: Subjective Data (a) Fever and extreme fatigue. (b) All medications taken, over-the-counter or prescription, are considered possible causes.
Agranulocytosis: Objective (a) Fever over 100.6oF. (b) Erythema and pain from ulcerations. (c) Lung auscultation may reveal crackles and rhonchi due to exudates (pneumonia).
Agranulocytosis: WBC with differential shows decreased WBCs in all categories.
Agranulocytosis: Bone marrow biopsy show suppressed activity.
Agranulocytosis: Culture ulcerations identify possible infectious organisms.
Agranulocytosis: Medical Management (1) Main objective is to alleviate bone marrow depression and prevent or treat infections. (2) Treat neutropenic patient with G-CSF (Neupogen) - a bone marrow stimulant
Agranulocytosis: nursing Interventions Protect against infection. Provide high-protein, high calorie diet to maintain nutritional status. Encourage fluids to promote hydration. Pt. Teaching.
Leukemia Malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes
Leukemia: Causes Idopathic. Genetic origins. Viruses. Exposure to radiation or chemotherapeutic agents.
Leukemia: Whats happening Bone marrow is replaced by rapidly developing white cells. Abnormal concentration and forms of immature cells found in circulation. These cells infiltrate the lymph nodes, spleen and liver.
S/S of Infiltration with Leukemia Hepatomegaly, splenomegaly, lymphadenopathy, bone pain, meningeal irritation, and oral lesions.
Three classes of Leukemia Lymphocytic Myelogenous Monocytic
Leukemia: Clinical Manifestations Anemia (pallor, fatigue, malaise, decreased activity tolerance). Thrombocytopenia (petechiae, epistaxis, easy bruising, occult blood in urine or stool). Leukopenia (fever, URI, UTI). Enlarged lymph nodes and painless splenomegaly may be first sign.
Leukemia: CBC Shows low, elevated or severely elevated WBCs.
Leukemia: Bone Marrow Biopsy Shows immature leukocytes
Leukemia: Lymph node biopsy shows excessive blasts (immature WBCs)
Leukemia: Chest Radiograph may show mediastinal lymph nodes, lung involvement and/or bone changes.
Leukemia: Peripheral Smear shows immature WBCs
Leukemia: CT/Lumbar puncture identifies leukemic cells outside of the blood and bone marrow
Leukemia: Subjective Data (a) Pain in bones or joints. (b) Fatigue, malaise, and irritability. (c) Bleeding abnormalities. (d) Increased activity intolerance
Leukemia: Objective Data (a) Presence of infection. (b) Occult blood in stools and urine. (c) Petechiae, ecchymosis, bleeding of mucous membranes. (d) CBC.
Acute Leukemia: Treatment Use of complex combination of chemotherapeutic drugs and total body radiation (Type of chemotherapy, or combination depends on disease process).
Acute Leukemia: If remission is achieved... Bone marrow transplant is the treatment of choice.
Autologous Bone Marrow Transplant 1. Bone marrow is removed from the patient and irradiated. 2. Patient receives chemotherapy. 3. Irradiated bone marrow is reinfused.
Allgenic Bone Marrow Transplant Marrow is from a donor.
Stem cell transplant from donor cord blood, peripheral blood or bone marrow
Chronic Leukemia (Exclusive to adults): Treatment 1) Occurs almost exclusively in adults. 2) Drug therapy includes: a) Chlorambucil (Leukeran). b) Hydroxyurea. c) Corticosteroids. d) Cyclophosphamide (Cytoxan). 3) Drug therapy is palliative, not curative. 4) Iradiation of lymph nodes.
Leukemia Blood transfusion. If anemia is severe. (a) PRBCs, platelets, FFP. (b) Blood products are irradiated and CMV negative.
Leukemia: Nursing interventions Prevention of infection. Prevention of hemorrhage. Pain control. Monitor for feelings of abandonment & loneliness. Watch for side effects of chemotherapy Obtain thorough knowledge of chemotherapeutic and prophylactic drugs.
Acute lymphocytic leukemia (ALL): prognosis Untreated patients 4-6 month median survival rate. With current therapy survival rate increases to 5 years and approximately 50% of children with ALL can be cured. (a) Current therapy is vincristine/prednisone and daunorubicin or doxorubicin.
Acute myelogenous leukemia (AML): Prognosis (1) Remissions can be achieved in 75% of cases. (2) Relapse will eventually occur in most patients. Only 20 - 25% of adults experience a 5-year remission.
Chronic lymphocytic leukemia: Prognosis (1) Overall survival is variable. (2) Early stage median survival rate is 10 -12 ½ years. (3) Advanced stage median survival rate is approximately 18 months.
multiple myeloma Malignant neoplastic immunodeficiency disease of the bone marrow. The tumor, composed of plasma cells, destroys osseous tissue, especially in flat bones, causing pain, fractures, and skeletal deformities.
multiple myeloma: plasma cells do this proliferate, destroying bone and crowding the bone marrow. Production of RBCs, WBCs and platelets is severely affected.
multiple myeloma causes this Causes abnormal antibody formation, making patients more susceptible to infection
multiple myeloma: onset Onset is gradual and insidious. (a) Disease is often unnoticed for years. (b) Patients experience recurrent bacterial infections.
multiple myeloma: clinical manifestation Malignant plasma cells proliferate and develop single or multiple bone marrow tumors. Bone destruction, disseminate into lymph nodes, liver, spleen, and kidneys. Bone pain. Pancytopenia increased risk for bleeding infection and anemia. Hypercalcermia.
Bence-Jones protein an immunoglobulin produced by malignant plasma cells. Used as the primary marker for multiple myeloma. This protein impairs the renal tubules which contributes to renal damage. High protein levels can lead to renal failure.
multiple myeloma: Subjective data C/O pain with movement. Assess emotional and spiritual support and understanding of disease process.
multiple myeloma: objective data Expressions of pain. Ability to perform activities of daily living. Fever, signs/symptoms of infection (especially respiratory and urinary). Monitor for bleeding. Changes in urine characteristics Assess for effectiveness of medicaitons
multiple myeloma: CBC Pancytopenia
multiple myeloma: Radiographic studies shows widespread demineralization of bone, lytic lesions and osteoporosis.
multiple myeloma: Bone marrow biopsy shows large number of immature plasma cells.
multiple myeloma: blood and urine can identify monoclonal protein which is a marker for myeloma cells.
multiple myeloma: Protein electrophoresis shows Bence-Jones protein.
multiple myeloma: Medical management (1) Treatment is symptomatic, as multiple myeloma is incurable. (2) Radiation and chemotherapy is aimed at reducing tumor size and impeding tumor growth and produce remission.
multiple myeloma drugs: Antineoplastics Alkylating agents. 1) Melphelan (Alkeran). 2) Cyclophosphamide (Cytoxan). 3) Chlorambucil (Leukeran). 4) Carmistine (BCNU).
multiple myeloma: nursing interventions Enforce neutropenic precautions. Maintain strict aseptic technique. Strict hand washing. Maintain Hydration.
Created by: jtzuetrong