leukemia

Leukemia
Leukemia is a fatal neoplastic disease that involves bone marrow, spleen & lymph nodes. It characterized by abnormal proliferation & maturation of one type of white blood cells ( lymphocytes, monocyte ,granulocyte)

Leukemia etiology
1- Unknown cause Predisposing factors includes: 1- Genetic factors: chromosome disorders 2-Radiation: radiologists 3-Chronic exposure to certain chemicals: benzene, aromatic hydrocarbon, dye users 4- Drugs: antibiotics, chemotherapy 5-Viruses

pathophysiology
DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide chaotically. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells - and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood.

Classifications
Leukemias are also subdivided into the type of affected blood cell. If the cancerous transformation occurs in the type of marrow that makes lymphocytes, the disease is called lymphocytic leukemia. A lymphocyte is a kind of white blood cell inside vertebrae immune system. If the cancerous change occurs in the type of marrow cells that go on to produce red blood cells, other types of white cells, and platelets, the disease is called myelogenous leukemia. there are two groups of four main types of leukemia,

Classifications

Acute Lymphatic leukemia

It characterized by rapid onset & fatal This is the most common type of leukemia among young children, although adults can get it as well, especially those over the age of 65. Survival rates of at least five years range from 85% among children and 50% among adults. It is result from an uncontrolled proliferation of immature cells derived from lymphoid stem cell.

Acute myeloid leukemia

AML is more common among adults than children, and affects males significantly more often than females. Patients are treated with chemotherapy. 40% of treated patients survive for over 5 years. It is result from defect in hemapoietic stem cell that differentiates into all myeloid cells

Chronic Lymphocytic Leukemia (CLL

It has a gradual onset & slower course(2-5 years) This is most common among adults over 55, although younger adults can get it as well. CLL hardly ever affects children. The majority of patients with CLL are men, A more aggressive form of CLL is B-cell prolymphocytic leukemia. Lymphoadenopathy occur with enlarged with nods &painful

Chronic Myeloid Leukemia

(CML) - The vast majority of patients are adults. 90% of treated patients survive for over 5 years. Whit blood cells more mature appearing but still ineffective cells.

Manifestation
1-Prodromal period: headache ,fatigue, sore throat ,night sweats& short of breath ,low grade fever 2- General weakness ,wt loss& anemia 3-Vulnerability to infection: mouth ulceration, tonsillitis 4-Bleeding tendencies due to thrombocytopenia 5-Swelling & pain in bone & joint 6-Enlargment painful lymphnodes 7-Splenomegaly(soft in acute lukemia, hard in chronic)

Manifestation
8-hepatomegaly 9-purpura, petechiae ,ecchymosis & infection of skin 10-Hyperuricemia(due to destruction of abnormal leukocytes the increased in urine) 11-Innfiltrate to retina-------visual disturbance 12-Enlarged kidney-----pyelonephritis 13-GIT bleeding 14-pleural infusion, pneumonia 15-increase intracranial pressure due to thrombosis or hemorrhage

Diagnosis
1-blood examination : decrease in both erythrocytes and platelets. Although the total leukocyte count can be low, normal, or high. (WBC over 100.000-200.000) 2- bone marrow examination(excess immature blast cell) 3-chromosome analysis, 4- urate level raised due to cell turn over is low 5-lover function test 6-Abnormal clotting, prolonged prothrombin

Managements
Aim: * to destroy leukemic cell without destroy residual normal cell *To complete remission

A pharmacological managements
(induction,conolidation,maintaince) 1-Acute myloid lukemia: 1-chemotherapy, called induction therapy, Aim :to eradicate the leukemic cells ,but this is often accompanied by the eradication of normal types of myeloid cells. Side effect: anemic, and thrombocytopenic (a platelet count of less than 10,000/mm3 is common). During this time: very ill, with bacterial, fungal, and viral infections, bleeding, and severe mucositis, diarrhea and anorexia

A pharmacological managements
B-Supportive care consists of administering blood products (RBCs and platelets) and promptly treating infections 2-consolidation therapy: to eliminate any residual leukemia cells that are not clinically detectable, thereby diminishing the chance for recurrence. 3-Maintainace:repeat cycle of dug adminsteration up to 2 years * Bone marrow transplantation

A pharmacological managements
2-Chronic myloid , lymphocytic leukemia 1- oral formulation of a tyrosine kinase inhibitor preventing a series of chemical reactions that cause the cell to grow and divide 2-Conventional therapy through correct chromosomal abnormality by using interferon 3-Decrease WBCS by using oral chemotheraby as hydroxyurea

A pharmacological managements
3-Antibiotics Radiotherapy 4-Splenectomy Immunotherapy 5- Corticosteroid

Non pharmacological managements

Assessment
1-Health history 2-physical examination(inspection, palpation). 3-Weakness and fatigue are common manifestations& signs of recurrent infections 4-Observe signs of bleeding(skin, GIT, mouth ulcer) Petechiae (usually located on trunk, thighs), ecchymoses or hematomas, conjunctival hemorrhages, bleeding gums, bleeding at puncture sites . 5-Lab investigations(Monitor complete blood count (CBC), platelets)

Impaired gas exchange Impaired mucous membranes due to changes in epithelial lining of the gastrointestinal tract from chemotherapy or prolonged use of antimicrobial medications Imbalanced nutrition, less than body requirements, related to hypermetabolic state, anorexia, mucositis, pain, and nausea Acute pain and discomfort related to mucositis, WBC infiltration of systemic tissues, fever, and infection Hyperthermia related to tumor lysis and infection Fatigue and activity intolerance related to anemia and infection

Nursing diagnosis

Nursing diagnosis
Risk for infection and bleeding Risk for impaired skin integrity related to toxic effects of chemotherapy, Risk for excess fluid volume related to renal dysfunction, hypoproteinemia, need for multiple intravenous medications and blood products Diarrhea due to altered gastrointestinal flora, mucosal denudation Risk for deficient fluid volume related to potential for diarrhea, bleeding, infection, and increased metabolic rate Self-care deficit due to fatigue, malaise, and protective isolation Anxiety due to knowledge deficit and uncertain future Disturbed body image related to change in appearance, function, and roles

Planning and Goals

*maintenance of adequate nutrition, activity tolerance, *ability for self-care and to cope with the diagnosis and prognosis. * positive body image, and an understanding of the disease process and its treatment.

Nursing Interventions
Preventing or managing bleeding & infection Managing mucositis Improving nutritional intake. Reduce pain, fatigue Maintain fluid & electrolyte balance Improve self care Reduce anxiety Pervent complications(Infection, Bleeding, Renal dysfunction, Tumor lysis syndrome, Nutritional depletion, Mucositis

Nursing care
1-Frequent check vital signs/4 hrs to detect early signs of infection 2-Mouth care/2 hrs & daily examination of mouth 3-periodic examination of WBC& platlets count 4-culture for wound, urine, throat& mouth lesion 5-using aseptic techniques, isolate patient during administering chemotherapy 6-provide adequate rest & sleep 7-provide adequate foods high in protein& vitamins

Nursing care
8-Give small frequent soft & none irritant food 9-Intake & out put chart 10- Fluid intake3000-4000ml/ day to dilute uric acid and out in urine 11-Nursin g measure to control fever 12-Nursin g measure to control bleeding:-inspect skin ,urine, mouth, stool for bleeding -Avoid trauma& invasive procedure 13-Control pain & alleviate anxiety