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disorders agranulocytoma, leukemia, patho, s/s, dx, treatment, nursing implicati

AGRANULOCYTOSIS,A severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils) Low white blood count Bone marrow suppression Fatality may result from severe bacterial infections
AGRANULOCYTOSIS Common Causes Adverse medication reaction or toxicity Neoplastic disease Chemotherapy and radiation therapy Viral and bacterial infections Heredity
AGRANULOCYTOSIS Clinical Manifestations Fever and chills Headache and fatigue Ulcerations of the mucous membranes Bronchial pneumonia and urinary tract infections in later stages
AGRANULOCYTOSIS Assessment Subjective Fever and extreme fatigue Objective Fever over 100.6 F Erythema and pain from ulcerations Crackles and rhonchi due to exudates
AGRANULOCYTOSIS Diagnosis WBC w/differential- decreased WBC Bone marrow biopsy – suppressed activity Cultures to identify possible infective organism
AGRANULOCYTOSIS Medical Management Main objective- alleviate bone marrow depression and treat infections Treatment based on organism and drug sensitivity Neutropenic precautions Transfusions as needed
AGRANULOCYTOSIS Nursing Interventions Protect against infection Monitor pt closely Handwashing and strict asepsis Observe for s/s of infection Enforce neutropenic precautions Prevent infected visitors from contact w/pt Monitor mucous membranes for ulcerations
AGRANULOCYTOSIS Nursing Interventions Provide high protein, high calorie diet Encourage fluids Pt teaching S/S of infection Frequent oral hygiene Avoid crowds, infected people, cold or hot environment Medication, diet and rest
LEUKEMIA,A malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes White cells replaces bone marrow Abnormal concentration and forms of immature cells found in circulation These cells infiltrate lymph nodes, spleen and liver and cause damage
LEUKEMIA Causes Unknown but attributed to: Genetic origins Viruses Exposure to radiation or chemotherapeutic agents
LEUKEMIA Clinical Manifestations Anemia Thrombocytopenia (petechiae, epistaxis, easy bruising) Leukopenia (fever, URI, UTI) Enlarged lymph nodes and painless splenomegaly may be first sign
LEUKEMIA Diagnostic Tests CBC- low, elevated WBC's Bone marrow biopsy – immature leukocytes Lymph node biopsy – excessive immature WBCs Chest radiograph – mediastinal lymph nodes, lung involvement and/or bone changes Peripheral smear – immature WBCs CT/Lumbar punctr
LEUKEMIA Assessment Subjective Pain in bones or joints Fatigue, malaise, and irritability Bleeding abnormalities Objective Infection Occult blood in stools and urine Petechiae, ecchymoses, bleeding of mucous CBC
LEUKEMIA Medical Management Goal – achieve remission Treatment is aimed at chemotherapy or bone marrow transplant Acute- mix of chemotherapeutic drugs and total body radiation Chronic-Chlorambucil, Hydroxyurea, Corticosteroids (doesn't cure) Blood trnsfx 4 anemia
LEUKEMIA Nursing Interventions Goal: Prevention of infection Neutropenic precautions Pt teaching on the avoidance of infect agents Frequent observation for s/s of infection Monitor for graft vs. host complications
LEUKEMIA Nursing Interventions Goal: Prevention of hemorrhage Monitor CBC, report abnormal results Protect patient from trauma Goal: Pain control Provide non-pharmacological comfort measures Provide analgesics as order and monitor effects
LEUKEMIA Nursing Interventions Monitor for feelings of abandonment and loneliness Monitor and treat side effects of chemo/rad Obtain thorough knowledge of chemo and prophylactic drugs Encourage pt to verbalize anxiety, fear, anger, helplessness Recommend community support groups
LEUKEMIA Patient Teaching S/S of infection Avoiding infected persons Contact physician for s/s of infection Medication/dietary All procedures and interventions to patient and family
ALL-Acute lymphocytic leukemia Prognosis Untreated pts 4-6 month survival rate Current therapy vincristine/prednisone and daunorubicin or doxorubicin increase survival rate to 5 years; 50% of kids can be cured
AML-Acute myelogenous Prognosis Remission w/ 75% of cases 20-25% of adults experience 5 yr remission
Chronic lymphocytic leukemia Prognosis Prognosis
MULTIPLE MYELOMA Etiology/Pathophysiology Malignant neoplastic immunodeficiency disease of the bone marrow The tumor destroys osseous tissue. Plasmas cells proliferate, destroys bone by crowding bone marrow RBCs, WBCs, and plateletS affected infect
MULTIPLE MYELOMA Clinical Manifestations Development of bone marrow tumors/malignant plasma cells Bone destruction Bone pain, kinesia Pathological fractures due to osseous changes Pancytopenia, hypercalcemia-renal prob, Bence Jones protein-marker
MULTIPLE MYELOMA Assessment Subjective Pain with movement Assess emotional and spiritual support Objective Expressions of pain Able to perform ADL Fever, s/s of infection esp resp. and urinary Monitor for bleeding
MULTIPLE MYELOMA Diagnosis CBC – pancytopenia Radiographic studies-demineralization of bone, lytic lesions and osteoporosis Bone marrow biopsy – large amt of immature plasma cell Blood and urine- monoclonal protein is marker Protein electrophoresis – Bence Jones protein
MULTIPLE MYELOMA Medical Management Treatment is symptomatic; disease is incurable Radiation and chemotherapy Antineoplastic drugs Monitor CBC Treat hypercalcemia and pain
Nursing Process for a Patient with Disorders of Leukocytes or Plasma: DX & Goal Risk for infection, r/t depressed WBC production Goal: Patient will remain free from infection Maintain neutropenic precautions/clean patient environment.
Nursing Process for a Patient with Disorders of Leukocytes or Plasma: Interventions Teach/assess/observe signs/symptoms of infection. Provide high protien, high calorie, high vitamin diet Monitor CBC and report abnomal values Administer antibiotics, as ordered
Nursing Process for a Patient with Disorders of Leukocytes or Plasma: DX & Goal Pain, related to infiltration of organs, bone destruction Goal: Patient will express adequate pain control
Nursing Process for a Patient with Disorders of Leukocytes or Plasma: Interventions Provide non pharmacologic comfort measures Provide analgesic as ordered and monitor effect
Nursing Process for a Patient with Disorders of Leukocytes or Plasma:DX & Goal Hemorrhage, related to decreased physiologic clotting capabilities secondary to thrombocytopenia Goal: Patient will experience no complications from hemorrhage
Nursing Process for a Patient with Disorders of Leukocytes or Plasma:Interventions Assess extent of bleeding Control bleeding Monitor vital signs and lab results- report abnormal values Administer blood, blood products as ordered Monitor tissue perfusion and organ function
Summary Described the etiology/pathophysiology, s/s, assessment, diagnosis, medical management and nursing interventions of agranulocytosis. Described the said factors of leukemia, chronic/acute leukemia, multiple myeloma, leukocyte/plasma disorders
Created by: redhawk101