disorders agranulocytoma, leukemia, patho, s/s, dx, treatment, nursing implicati
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| 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
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| AGRANULOCYTOSIS Common Causes | Adverse medication reaction or toxicity Neoplastic disease Chemotherapy and radiation therapy Viral and bacterial infections Heredity
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| AGRANULOCYTOSIS Clinical Manifestations | Fever and chills Headache and fatigue Ulcerations of the mucous membranes Bronchial pneumonia and urinary tract infections in later stages
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| AGRANULOCYTOSIS Assessment | Subjective Fever and extreme fatigue Objective Fever over 100.6 F Erythema and pain from ulcerations Crackles and rhonchi due to exudates
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| AGRANULOCYTOSIS Diagnosis | WBC w/differential- decreased WBC Bone marrow biopsy – suppressed activity Cultures to identify possible infective organism
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| AGRANULOCYTOSIS Medical Management | Main objective- alleviate bone marrow depression and treat infections Treatment based on organism and drug sensitivity Neutropenic precautions Transfusions as needed
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| 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
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| 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
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| 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
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| LEUKEMIA Causes | Unknown but attributed to: Genetic origins Viruses Exposure to radiation or chemotherapeutic agents
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| LEUKEMIA Clinical Manifestations | Anemia Thrombocytopenia (petechiae, epistaxis, easy bruising) Leukopenia (fever, URI, UTI) Enlarged lymph nodes and painless splenomegaly may be first sign
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| AML-Acute myelogenous Prognosis | Remission w/ 75% of cases 20-25% of adults experience 5 yr remission
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| Chronic lymphocytic leukemia Prognosis | Prognosis
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| 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
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| 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
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| 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
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| 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
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| MULTIPLE MYELOMA Medical Management | Treatment is symptomatic; disease is incurable Radiation and chemotherapy Antineoplastic drugs Monitor CBC Treat hypercalcemia and pain
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| 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.
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| 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
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| 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
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| Nursing Process for a Patient with Disorders of Leukocytes or Plasma: Interventions | Provide non pharmacologic comfort measures Provide analgesic as ordered and monitor effect
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| 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
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| 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
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| 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
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