Lerios, Janine Kyla G.

Week 17: Course Task

BSN 3-YA-11 NCMB 312

1. Make a table to differentiate the 4 common types of leukemia: Acute lymphocytic leukemia (ALL), Chronic lymphocytic leukemia (CLL),
Acute myeloid leukemia (AML), and Chronic myeloid leukemia (CML) according to incidence, physiologic alterations, clinical
manifestations, management, and prognosis.
TYPES OF INCIDENCE PHYSIOLOGIC CLINICAL MANAGEMENT PROGNOSIS
LEUKEMIA ALTERATIONS MANIFESTATIONS

The prevalence is When DNA mistakes  Leukocyte 1. Induction Chemo – Depending on how
higher in adults over happen in bone numbers may Vincristine, corticosteroid far along the
45. The marrow cells, Acute be abnormally and anthracycline condition has
recommended Lymphocytic high or low progressed, this
course of treatment Leukemia (ALL) depending on 2. CNS treatment – Cranial type's prognosis is
for this condition is develops. Errors how many irradiation or Intrathecal sickness, but young
chemotherapy. induce cells to start immature chemotherapy with children aged 3 to 7
proliferating and lymphoblast methotrexate or cytarabine seem to be the
dividing, whereas there are. the best likelihood
stable cells often  The 3. Stem Cell Transplant – of full recovery.
Acute Lymphocytic prevent division and proliferation Offered only to high risk
Leukemia (ALL) finally die. Blood of immature Acute Lymphocytic
cell growth becomes lymphocytes Leukemia (ALL)
aberrant as a result. in the bone
marrow 4. Post Remission Therapy –
prevents the Consolidation/Intensification
growth of or Maintenance Therapy
healthy
myeloid cells.
 Pain due to a
swollen or
enlarged liver
 Discomfort in
the bone
 Cranial nerve
palsies
 Headache
  Meningeal
involvement
resulting in
vomiting

This kind rarely The proliferation of  Deficiency 1. Chemotherapy This disease

affects kids and has CD5+ CD23+ B  Exhaustion 2. Stem Cell Transplant progresses slowly. If
a substantially cells in blood, bone  Hyperpyrexia 3. Radiation Therapy the disease affects B
higher marrow, and  Weight Loss cells, life expectancy
greater frequency in secondary lymphoid  Sweating at can range from 10 to
older persons of 60. tissue distinguishes night 20 years if treatment
Males are more Chronic  Increased is started early.
Chronic often afflicted Lymphocytic lymphocyte
Lymphocytic than females. Leukemia (CLL) count
Leukemia (CLL) from other types of  Enlarged
leukemia. According lymph nodes
to gene expression (usually felt as
patterns and lumps under
phenotypic research, the skin)
CD5+ B  Abdominal
lymphocytes, which pain
are comparable to
those present in
healthy adult blood,
are likely the source
of CLL.

Adults typically Myeloblasts are  Fever 1. Cytarabine for CNS Acute myeloid
exhibit this type. immature leukocyte  Infection disease leukemia, which is a
Statistics reveal that reservoirs found in  Pallor 2. Induction Chemotherapy more severe
20% to 40% of myeloid cells.  Dizziness 3. Post remission variation of the
patients survive for Genetic changes that  Dyspnea on illness, is
Acute Myeloid at least 60 months inhibit cell exertion characterized by a
Leukemia (AML) with early maturation and  Inadequate faster progression of
identification. differentiation may production of the illness. Adults
occur in this normal blood typically experience
myeloblast. cells this style. Statistics
  Weakness reveal that 20% to
 Fatigue 40% of patients
survive for at least
60 months with
early identification.
Chemotherapy is the
prescribed course of
treatment. Those
affected, who are 60
years of age and
older, have very low
life expectancies.

In people under the Myeloid progenitor  Fatigue 1. Oral Formulation of a The prognosis is
age of 20, it is cells build up in the  Anemia tyrosine kinase inihibitor, based on how far
uncommon. With bone marrow and  Dyspnea imatinib meyslate (Gleevec) along the disease is.
age, the incidence blood in Chronic  Discomfort in Patients in the early
rises. Myeloid Leukemia bone 2. Other treatment options stages have a 98-
(CML), a stem cell  Splenomegaly may be taken into account month life
disease. The genes  Weight loss when imatinib (at expectancy, those in
that generate  Fever conventional doses) fails to the middle stages
chromosomal 9 and  Blood count induce a molecular have a 65-month life
22 translocations are begin to worse remission or when that expectancy, and
Chronic Myeloid aberrant in this cell.  On analysis, remission is not sustained. those in the late
Leukemia (CML) significant These options include stages have a 42-
chromosomal increasing imatinib dosage month life
alterations can (with increased toxicity), expectancy. Patients
be visible. using another BCR-ABL with chronic
inhibitor (such as dasatinib myelogenous
[Sprycel]), or using an leukemia had a
allogeneic transplant. median survival
time of 117 months.
3. Additional therapeutic In the upcoming
options include peripheral years, several
blood stem cell medications that are
transplantation and bone still in clinical
marrow transplantation. studies could alter
4. Treatment for the acute the situation and
stage of chronic myeloid increase survival.
leukemia (blast crisis)
utilizing the same drugs as
for acute myeloid leukemia
or acute lymphocytic
leukemia may mimic
induction therapy for acute
leukemia.

5. Oral chemotherapy drugs,

usually busulfan or
hydroxyurea
Leukapheresis (leukocyte
count of more than
300,000/mm3); Myleran
Daunomycin [Cerubidine],
for example, is an
anthracycline
chemotherapeutic drug used
only in palliative care (rare).
 2. Formulate a Nursing Care Plan for a patient with Acute Leukemia.

ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

Subjective: Risk for bleeding related to Short Term: Independent: Short Term:
“Okay naman ako pero decreased platelet count After 4 hours of nursing After 4 hours of nursing
medyo nanghihina pa rin” intervention, the patient 1. Examine body systems intervention, the patient:
as verbalized by the patient will be able to: for bleeding every shift and
check vital indicators every  Displayed skin
Objective:  Display skin four hours: appearances
appearances without any
 Ecchymoses over without any  Skin, mucous bleeding signs.
anterior lower bleeding signs membranes for  Mucous membrane
extremeties  Mucous membrane petechiae, is intact.
 Weakness will remain intact ecchymoses, and  Goal met.
 Pale palpebral hematoma
conjunctiva Long Term: formation.
 Blood count result  Gums and nasal
reduced: After 3 days of nursing Long Term:
intervention, the patient membranes for
- HGB: 88 bleeding After 3 days of nursing
- Platelet: 59 will be able to:
 Vomitus, stool and intervention, the patient:
- HCT: 0.246  Urine Stool will be urine for visible
free from blood  Blood is absent
occult blood
 Normalized blood from the feces and
 Neurologic changes
count result urine.
(e.g., headache,
 Normal blood count
visual changes,
result.
decreased LOC
 Goal met.
seizure)

2. Encourage use of soft-

bristle toothbrush, sponge
or mild mouthwash to
clean teeth and gums.
3. Instruct client to avoid
forceful blowing,
coughing, sneezing and
straining to have a bowel
movement.

4. Apply pressure to
injection sites for 3 to 5
minutes and arterial
punctures for 15 to 20
minutes

5. Avoid invasive
procedures as possible
(e.g., rectal temperature,
inserting suppositories,
parenteral injection)

6. Notify the cafeteria to

provide soft diet for this
patient

Dependent:

 Inform the doctor

about the need for
medications that
can make it easier
for the patient to
pass feces so as to
prevent irritation of
the patient's anus.

Collaborative:

 Monitor laboratory
studies; e.g.,
 platelets, Hb/Hct,
clotting.
 Administer RBCs,
platelets, clotting
factors.