Professional Documents
Culture Documents
PRESENTED BY:
Abhishek Yadav
M Sc Nursing 1st Year.
SPECIFIC OBJECTIVES
• Introduction of Leukemia.
• Definition of Leukemia.
• Incidence of Leukemia.
• Etiology & Risk factors of Leukemia.
• Pathophysiology of Leukemia.
• Types of Leukemia.
• Clinical manifestations of Leukemia.
• Diagnostic evaluation of Leukemia.
• Management of Leukemia.
INTRODUCTION
Cancers of hematopoietic system are disorders that
result from proliferation of malignant cells.
Malignant cells are originated in bone marrow,
Thymus, and lymphatic tissue.
Blood cells that originate in bone marrow are called
hematopoietic cells.
Blood cells that originate in lymph are called
lymphoid cells.
Leukemia (Cancer of Bone marrow)
Lymphoma (Cancer of lymphoid tissue)
DEFINITION
Leukemia is a malignant disease of the blood- forming
organs.
Leukemia is a malignant progressive disease in which
the bone marrow & other blood forming organs
produce increased no. of immature / abnormal
leucocytes, these suppresses the production of
normal blood cells, leading to anemia & other
symptoms.
INCIDENCE (in India)
• About 3- 4 per 100,000 population.
Retinoid:
– Tretinoin.
Anti-metabolites:
– Cytarabine,
– 6-thioguanine.
Miscellaneous:
– Arsenic tri-oxide.
Combination of cytarabine and anti-tumor
antibiotic.
2. For acute lymphocytic leukemia:
Alkylating agents:
– Cyclophosphamide.
Anti-tumor antibiotics (anthracycline):
– Daunorubicin,
– Doxorubicin.
Anti-metabolites:
– Cytarabine,
– 6-mercaptopurine,
– methotrexate
Corticosteroids:
– Prednisolone,
– Dexamethasone.
Mitotic inhibitors / Vinca alkaloids:
– Vincristine.
Biologic / targeted therapy:
– Dasatinib.
Miscellaneous:
– L-asparaginase.
– Pregaspargase.
Other therapies:
– Cranial radiation,
– Intrathecal methotrexate or cytarbine
3. Chronic myelogenous leukemia:
Biologic / targeted therapy:
– Imatinib,
– Dasatinib.
Miscellaneous:
– Hydroxyurea.
Combination chemotherapy including any of :
– Cytarabine,
– thioguanine,
– Daunorubicin,
– Methotrexate,
– Prednisone,
– Vincristine,
– L-asparaginase,
– Carmustine,
– 6-mercaptopurine.
Other therapies:
– Radiation (total body / spleen).
4. Chronic lymphocytic leukemia:
Alkylating agents :
– Chlorambucil,
– Cyclophosphamide.
Antimetabolites:
– Fludarabine.
Corticosteroid:
– Prednisone.
Biologic / targeted therapy:
– Alemtuzumab,
– Rituximab.
Miscellaneous:
– Pentostatin.
Other therapies:
– Radiation (total body, lymph nodes, or spleen)
SURGICAL MANAGEMENT:
1. For acute myelogenous leukemia:
Autologous or allogeneic hematopoietic stem
cell transplant.
2. For acute lymphocytic leukemia:
Allogeneic hematopoietic stem cell
transplant.
3. For chronic myelogenous leukemia:
Hematopoietic cell transplant, alpha-
interferon, leukapheresis.
4. For chronic lymphocytic leukemia:
Spleenoctomy, allogeneic hematopoietic stem
cell transplant.
• NURSING MANAGEMENT:
Asessment:
Nursing diagnosis:
1.Ineffective protection / risk for infection related to
neutropenia or leukocytosis secondary to
leukemia or treatment.
Intrvention:
• Assessing client.
• handwashing techniques.
• Client isolation.
• Low bacteria diet (excluding fruits & vegetables).
• Daily bath with antibacterial soap.
• Maintain oral hygiene.
• Daily stool softeners (to reduce anal fissures).
• Perineal cleansing for every bowel movement.
• Avoid rectal suppositories & rectal thermometer.
• Temperature should be taken (oral, axilla,
tympanic) every 4 hourly, report if more than
100.5 0 F or lower than 97.50 F ( because fever is
only the symptom in neutropenic client).
2. Decreased cardiac output related to
thrombocytopenia secondary to either leukemia
or treatment.
Intervention:
• Institute bleeding precautions:
– Provide a soft toothbrush for oral hygiene
– Avoid commercial mouthwash containing alcohol.
– Avoid blowing or picking nose, straining at bowel
movements, douching or using tampons, using razors
during neutropenic phase.
– Don’t administer IM/SC inj.
– Do not insert rectal suppository.
– Avoid aspirin containing drugs.
– Avoid urinary catheterization, if needed then only
lesser sized.
– Avoid mucosal trauma during suctioning.
– Remove all sharp objects around client.
– Use pressure reducing mattress, proper change the
position.
– Use only paper tape ,avoid strong adhesive (can cause
skin adhesions).
3. Fatigue related to side effects of treatments,
low haemoglobin levels, pain, lack of sleep.
Intervention:
• Assess for anemia.
• Assess for physical, mental and treatment
related causes of fatigue.
• Encourage exercise to maintain strength.
• Allow for rest.
4. imbalanced nutrition less than body
requirements related to anorexia, pain or fatigue.
Intervention:
• Administer anti-emetics. (before meal/ drinking).
• Administer local IV anlagesics.
• Provide high Cho meals & oral supplements.
• Weigh daily.
• If client can not tolerate oral foods for an
extended period, begin TPN, as ordered.
• Monitor intake.
5. Disturbed body image resulting from alopecia,
weight loss and fatigue.
Intervention:
• Before treatment , inform client about the
potential for hair loss over entire body.
• Encourage use of hats, etc as desired.
• Explain the temporary nature of allopecia.
• Encourage him to balance rest with exercise to
maintain muscle tone without developing severe
fatigue.
REFRENCES
• Joyce M Black, Jane Hokanson Howks, A textbook of
Medical Surgical Nursing Clinical Management for the
Positive outcomes, *th Edition, Philadelphia: Sounders
Elsevier 2009, Page no. -2115-24.
• Chintamani Lewis, Heit Kemper, Divksen, O’Brein, Bucher,
A Textbook of Medical Surgical Nursing Assessment and
Management of Clinical problems, New Dehli, Elseier,
2011, Page no.- 722-28.
• https://www.myoclinic.org/diseases-
conditions/leukemia/basics
• https://www.nursingcrib.com/pathophysiology-of-
leukemia/
THANKYOU