ACTIVITY 4.

1 CONCEPT MAP OF LEUKEMIA

RLE GROUP 2

ABANILLA, DIANE
ANG, AMIEL

BUERANO, JOMAR

FERNANDEZ, APRIL

PAPA, AIREEN

PIELAGO, RONALYN

PETILONA, DIANA

REGODON, ZHILLA

SACRISTIA, JANNICA
TALABONG SHAINELLE
 LEUKEMIA

-cancer of the body's

blood-forming tissues

Modifiable Risk Gene mutation Non-Modifiable Risk

Factors Factors

-Exposure to Immature blast cells losses the -Congenital Disorder

radiation ability to mature (Down syndrome)

-Exposure to benzene -Family history of

These immature blast cells dividing
(smoking) leukemia
rapidly without control
-Previous cancer
treatment Causing too much immature blast and a Bone and Acute pain
fewer mature cells in the bone marrow joint pain

Accumulation in the blood and

Administer
metastasize in different organs -Place in
Analgesic
position of
comfort

-Evaluate
Decreased Decreased level of pain
Decreased
Red Blood White Blood Platelets
-Avoid giving
Cells Cells aspirin
Splenomegaly Hepatomegaly
Risk for
infection Lymphadenopathy
Pallor Abdominal Discomfort

Low Excessive
Fatigue
grade bleeding

Shortness of fever
breath
Night Risk for
sweats bleeding
Ineffective
Breathing
-Limit straining with
Pattern -Monitor bowel movement,
WBC count forceful nose blowing,
coughing or sneezing
-Utilize pulse -Place in
-Use of soft-bristled Legend:
oximetry private room
toothbrush Dark green – Disease
-Position with -Provide tepid
proper body sponge bath -Avoid use of Light Green – Nursing Diagnosis
alignment toothpick or dental
Black – Causes
floss
-Provide Red – Pathophysiology
adequate rest
Yellow – Laboratory Result

Blue – Signs and Symptoms

Orange – Nursing Intervention

Violet - Pharmacologic
NURSING DIAGNOSIS

1. RISK FOR INFECTION RELATED TO ALTERED WHITE BLOOD CELL

MATURATION

INDEPENDENT NURSING ACTION

 Require good hand washing protocol for all personnel and visitors.- To prevents cross-
contamination and reduces risk of infection.

 Handle patient gently. Keep linens dry and wrinkle-free.-To prevents sheet, burn and
skin excoriation.

 Inspect for skin tender, erythematous areas and open wounds. Cleanse skin with
antibacterial solutions.- It may indicate local infection. Open wounds may not produce
pus because of insufficient number of granulocytes.

DEPENDENT NURSING ACTION

 Administer antibiotics as ordered by the physician.- The antibiotics will help to kill and
stop the proliferation and growth of the bacteria which could cause the infection.

LABORATORY/ DIAGNOSTIC TEST

 CBC, noting whether WBC count falls or sudden changes occur in neutrophils.

 Gram’s stain cultures and sensitivity.

 Review serial chest x-rays.

 Chemotherapy, radiation, and bone marrow transplant

2. ACUTE PAIN RELATED TO PHYSICAL AGENTS SUCH AS BONE MARROW

PACKED WITH LEUKEMIC CELLLS

INDEPENDENT NURSING ACTION

 Investigate reports of pain. Note changes in degree (use scale of 0–10) and site.-Helpful
in assessing need for intervention; may indicate developing complications.

 Monitor vital signs, note nonverbal cues, e.g., muscle tension, restlessness.- May be
useful in evaluating verbal comments and effectiveness of interventions.

 Place in position of comfort and support joints, extremities with pillows or padding.-May
decrease associated bone or joint discomfort.

LABORATORY/ DIAGNOSTIC TEST

 Bone marrow test. a procedure that removes a sample of bone marrow from your
hipbone. The bone marrow is removed using a long, thin needle. The sample is sent to a
 laboratory to look for leukemia cells. Specialized tests of your leukemia cells may reveal
certain characteristics that are used to determine your treatment options.

3. IMBALANCE NUTRITION RELATED TO LESS THAN BODY REQUIREMENTS

INDEPENDENT NURSING ACTION

 Explain to the patient and significant others the importance of maintaining proper
nutrition-    It will give a better understanding on the need of meeting the daily nutritional
requirements of the body.

 Note the patient’s perspective and feeling toward eating and food.-Various
psychological, psychosocial, religious, and cultural factors determine the type, amount,
and appropriateness of food utilized

DEPENDENT NURSING ACTION

 With the order of the physician administer supplements that will help the
patient with his or her nutritional deficit

COLLABORATIVE NURSING ACTION

 Work with client dietician to develop a plan for meal pattern- Immobility leads to
negative nitrogen balance that fosters anorexia

4. ACTIVITY INTOLERANCE RELATED TO GENERALIZED WEAKNESS

INDEPENDENT NURSING ACTION

 Encourage patient to keep a diary of daily routines and energy levels, noting
activities that increase fatigue.-Helps patient prioritize activities and arrange
them around fatigue pattern.

 Provide quiet environment and uninterrupted rest periods. Encourage rest

periods before meals.- Restores energy needed for activity and cellular
regeneration and/or tissue healing.

 Recommend small, nutritious, high-protein meals and snacks throughout the

day.- Smaller meals require less energy for digestion than larger meals.
Increased intake provides fuel for energy.

5. INEFFECTIVE TISSUE PERFUSION RELATED TO ALTERED AFFINITY OF

HEMOGLOBIN FOR OXYGEN

INDEPENDENT NURSING ACTION

 Assess for probable contributing factors related to temporarily impaired arterial blood
flow. Some examples include compartment syndrome, constricting cast, embolism,
indwelling arterial catheters, positioning, thrombus, and vasospasm.- Early detection of
the source facilitates quick, effective management.

 Avoid measures that may trigger increased ICP such as coughing, vomiting, straining
at stool, neck in flexion, head flat, or bearing down.- These will further reduce cerebral
blood flow.

 Record BP readings for orthostatic changes (drop of 20 mm Hg systolic BP or 10 mm Hg

diastolic BP with position changes).-Stable BP is needed to keep sufficient tissue
perfusion. Medication effects such as altered autonomic control, decompensated heart
failure, reduced fluid volume, and vasodilation are among many factors potentially
jeopardizing optimal BP.

DEPENDENT NURSING ACTION

 Administer IV Fluids as ordered by the physician- Sufficient fluid intake maintains

adequate filling pressures and optimizes cardiac output needed for tissue perfusion.

TREATMENT FOR LEUKEMIA

 Chemotherapy. Chemotherapy is the major form of treatment for leukemia. This drug treatment
uses chemicals to kill leukemia cells.

 Depending on the type of leukemia you have, you may receive a single drug or a combination of
drugs. These drugs may come in a pill form, or they may be injected directly into a vein.

 Biological therapy. Biological therapy works by using treatments that help your immune system
recognize and attack leukemia cells.

 Targeted therapy. Targeted therapy uses drugs that attack specific vulnerabilities within your
cancer cells.

 For example, the drug imatinib (Gleevec) stops the action of a protein within the leukemia cells
of people with chronic myelogenous leukemia. This can help control the disease.

 Radiation therapy. Radiation therapy uses X-rays or other high-energy beams to damage

leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large
machine moves around you, directing the radiation to precise points on your body.

 You may receive radiation in one specific area of your body where there is a collection of
leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be
used to prepare for a stem cell transplant.

 Stem cell transplant. A stem cell transplant is a procedure to replace your diseased bone marrow
with healthy bone marrow.

 Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to
destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells
that help to rebuild your bone marrow.
 You may receive stem cells from a donor, or in some cases you may be able to use your own
stem cells. A stem cell transplant is very similar to a bone marrow transplant.

PHARMACOLOGIC

 Midostaurin is used to treat certain types of blood cell cancer (acute myeloid leukemia-
AML, mast cell leukemia-MCL) or an immune system disorder (mastocytosis). It works
by slowing or stopping the growth of cancer cells and certain immune system cells (mast
cells).

 MYLOTARG (gemtuzumab) is indicated for the treatment of relapsed or refractory

CD33-positive acute myeloid leukemia in adults and in pediatric patients 2 years and
older. Precautions. Use appropriate measures to prevent tumor lysis syndrome.
CLADRIBINE is used to treat hairy cell leukemia (cancer of a certain type of white
blood cell).

 Cladribine is in a class of medications known as purine analogs. It works by stopping or

slowing the growth of cancer cells.

SURGICAL MANAGEMENT OF LEUKEMIA

 Placement of a venous access device – The surgical implantation of a plastic tube into a
large vein in the chest or upper arm can reduce the need for continual needle sticks for
drug injections, blood testing and bone marrow transplants, all of which may be
recommended during leukemia treatment.

 Lymph node biopsy – Although it is relatively uncommon for leukemia cells to

metastasize to lymph nodes, this can sometimes occur, particularly when the condition
transforms into Richter’s syndrome, a type of lymphoma. If a physician suspects lymph
node involvement, a lymph node can be surgically removed for evaluation under a
microscope.

 Splenectomy – Leukemia can sometimes cause the spleen to become clogged and
enlarged with excess tissue, which can lead to pain and impaired function. As a result, as
the spleen filters the blood, it can sometimes inadvertently destroy too many red blood
cells or platelets, leading to anemia. A splenectomy, or surgical removal of the spleen,
can help relieve the symptoms of anemia, including fatigue and shortness of breath.

 Bone marrow transplantation – A bone marrow transplant involves the injection of stem
cells into a vein, which can stimulate the production of healthy red blood cells, white
blood cells and platelets. By replacing cells that are lost through chemotherapy or
radiation therapy, a bone marrow transplant can allow a patient to receive higher and
more effective treatment dosages.