Exam 14: D/O of Leukocytes & Plasma
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| Agranulocytosis: broken down | Without-granulocytes-state of disease
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| Agranulocytosis | Potentially fatal condition of the blood, characterized by a severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils).
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| Leukopenia | The white blood count is low
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| neutropenia | absolute neutrophil count
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| Suppression of the bone marrow | reduces the production of white blood cells
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| Agranulocytosis: Causes | (a) Adverse medication reaction or toxicity.
(b) Neoplastic disease.
(c) Chemotherapy and radiation therapy.
(d) Viral and bacterial infections.
(e) Heredity.
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| 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.
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| Agranulocytosis: Subjective Data | (a) Fever and extreme fatigue.
(b) All medications taken, over-the-counter or prescription, are considered possible causes.
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| 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).
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| Agranulocytosis: WBC with differential | shows decreased WBCs in all categories.
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| Agranulocytosis: Bone marrow biopsy | show suppressed activity.
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| Agranulocytosis: Culture ulcerations | identify possible infectious organisms.
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| 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
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| Agranulocytosis: nursing Interventions | Protect against infection.
Provide high-protein, high calorie diet to maintain nutritional status.
Encourage fluids to promote hydration.
Pt. Teaching.
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| Leukemia | Malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes
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| Leukemia: Causes | Idopathic.
Genetic origins.
Viruses.
Exposure to radiation or chemotherapeutic agents.
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| 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.
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| S/S of Infiltration with Leukemia | Hepatomegaly, splenomegaly, lymphadenopathy, bone pain, meningeal irritation, and oral lesions.
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| Three classes of Leukemia | Lymphocytic
Myelogenous
Monocytic
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| 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.
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| Leukemia: CBC | Shows low, elevated or severely elevated WBCs.
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| Leukemia: Bone Marrow Biopsy | Shows immature leukocytes
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| Leukemia: Lymph node biopsy | shows excessive blasts (immature WBCs)
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| Leukemia: Chest Radiograph | may show mediastinal lymph nodes, lung involvement and/or bone changes.
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| Leukemia: Peripheral Smear | shows immature WBCs
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| Leukemia: CT/Lumbar puncture | identifies leukemic cells outside of the blood and bone marrow
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| Leukemia: Subjective Data | (a) Pain in bones or joints.
(b) Fatigue, malaise, and irritability.
(c) Bleeding abnormalities.
(d) Increased activity intolerance
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| Leukemia: Objective Data | (a) Presence of infection.
(b) Occult blood in stools and urine.
(c) Petechiae, ecchymosis, bleeding of mucous membranes.
(d) CBC.
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| Acute Leukemia: Treatment | Use of complex combination of chemotherapeutic drugs and total body radiation (Type of chemotherapy, or combination depends on disease process).
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| Acute Leukemia: If remission is achieved... | Bone marrow transplant is the treatment of choice.
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| Autologous Bone Marrow Transplant | 1. Bone marrow is removed from the patient and irradiated.
2. Patient receives chemotherapy.
3. Irradiated bone marrow is reinfused.
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| Allgenic Bone Marrow Transplant | Marrow is from a donor.
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| Stem cell transplant | from donor cord blood, peripheral blood or bone marrow
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| 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.
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| Leukemia Blood transfusion. | If anemia is severe.
(a) PRBCs, platelets, FFP.
(b) Blood products are irradiated and CMV negative.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| multiple myeloma: plasma cells do this | proliferate, destroying bone and crowding the bone marrow. Production of RBCs, WBCs and platelets is severely affected.
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| multiple myeloma causes this | Causes abnormal antibody formation, making patients more susceptible to infection
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| multiple myeloma: onset | Onset is gradual and insidious.
(a) Disease is often unnoticed for years.
(b) Patients experience recurrent bacterial infections.
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| 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.
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| 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.
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| multiple myeloma: Subjective data | C/O pain with movement.
Assess emotional and spiritual support and understanding of disease process.
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| 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
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| multiple myeloma: CBC | Pancytopenia
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| multiple myeloma: Radiographic studies | shows widespread demineralization of bone, lytic lesions and osteoporosis.
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| multiple myeloma: Bone marrow biopsy | shows large number of immature plasma cells.
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| multiple myeloma: blood and urine | can identify monoclonal protein which is a marker for myeloma cells.
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| multiple myeloma: Protein electrophoresis | shows Bence-Jones protein.
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| 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.
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| multiple myeloma drugs: Antineoplastics | Alkylating agents.
1) Melphelan (Alkeran).
2) Cyclophosphamide (Cytoxan).
3) Chlorambucil (Leukeran).
4) Carmistine (BCNU).
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| multiple myeloma: nursing interventions | Enforce neutropenic precautions.
Maintain strict aseptic technique.
Strict hand washing.
Maintain Hydration.
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