NUR252: UNITIII

NEOPLASTIC DISORDERS OF
THE HEMATOLOGIC SYSTEM
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL): DESCRIPTION
• A fast-growing cancer in which the body
produces a large number of immature white
blood cells (lymphocytes: B Cell T Cells and
Natural Killer). These cells can be found in
the blood, bone marrow, lymph nodes,
spleen, and other organs
• A malignant disease of the bone marrow in
which early lymphoid precursors proliferate
and replace the normal hematopoietic cells
of the marrow
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 2:
DESCRIPTION
• It is the most common malignancy
diagnosed in children, representing
nearly one third of all pediatric cancers
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 3: DIAGNOSTIC
TESTS
• CBC
• Bone marrow biopsy
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 4: ETIOLOGY
• Unknown
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 5:
PATHOPHYSIOLOGY
• Formation of immature WBC’s
• Production of fewer WBC’s
• Multiplication and infiltration of
immature cells causes damage to bone
marrow and other structures
• Normal bone marrow is replaced by
abnormal or immature WBC
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 6: SIGNS AND
SYMPTOMS
• Bleeding gums
• Bone pain or tenderness
• Easy bruising
• Excessive or prolonged bleeding
• Fatigue
• Fever
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 7: SIGNS AND
SYMPTOMS
• Joint pain
• Infection
• Menstrual irregularities
• Nosebleeds
• Paleness
• Palpitations
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 8: SIGNS AND
SYMPTOMS
• Pinpoint red spots on the skin
• Shortness of breath (made worse by
exercise)
• Swollen glands (lymphadenopathy)
• Swollen gums
• Unintentional weight loss
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 9: TREATMENT
• Induction therapy: The purpose of the first
phase of treatment is to kill most of the
leukemia cells in the blood and bone marrow.
-Chemotherapy
-Other drug therapy
Additional treatments may include:
• Transfusion of blood products, such as
platelets
• Antibiotics to fight infection
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 10: TREATMENT
• Consolidation therapy: also called
post-remission therapy, this phase of
treatment is aimed at destroying the
leukemia cells remaining in the brain or
spinal cord.
-Additional chemotherapy
-Radiation therapy
-Bone marrow transplant
-Stem cell transplant
 ACUTE LYMPHOCYTIC
LEUKEMIA (ALL) 11: TREATMENT
• Maintenance therapy: The third phase
of treatment prevents leukemia cells
from regrowing.
ACUTE LYMPHOCYTIC
LEUKEMIA (ALL)
NURSING
MANAGEMENT
 ASSESSMENT
• Nursing History-B wt loss, fever, frequency
of infections, increasing fatigue, SOB,
palpitations, visual changes, difficulty,
coughing, rectal pain
• Physical Exam- enlarged lymph nodes,
hepatomegaly, splenomagaly, skin
lesions, abnormal breath, hemorrhaging
 SAFETY AND SECURITY
• Nurse in private room
• Reverse barrier nursing
• Monitor for signs of infection
• Monitor for signs of haemorrhaging
• Strict medical asepsis
• Aseptic/sterile technique for invasive
procedures if necessary
• Avoid/limit invasive procedures
 SAFETY AND SECURITY2
• Provide frequent oral hygiene
• Use a soft toothbrush and avoid harsh
mouthwash
• Provide rest periods
• Ensure/provide adequate nutrition
• Meticulous skin/pressure area care
• Limit visitors especially those with URTI
• Restrict fresh fruits and vegetables
 SAFETY AND SECURITY3
• Monitor hemoglobin
• Avoid aspirin and nsaids
• Administer prescribed antibiotics
 PSYCHOSOCIAL
• Assess anxiety levels
• Assess ability to cope and coping skills
• Establish and maintain therapeutic
relationship
• Ensure/provide adequate information and
explanations
• Allow expression of feelings/grief
• Assist to negotiate grief process/stages
 PSYCHOSOCIAL2
• Relieve pain and discomfort
• Allow relatives/SO to visit/remain with pt
• Provide emotional support
• Spend time with patient other than to
provide care
• Use distraction/diversion therapy
• Allow spiritual advisor to visit if requested
• Administer prescribed sedative
 PSYCHOSOCIAL3
• Ensure referral to professional counsellor
• Allow significant other to voice feelings
 CHRONIC LYMPHOCYTIC
LEUKEMIA (CLL): DESCRIPTION
Chronic lymphocytic leukemia (CLL) is
a monoclonal disorder characterized
by:
• a progressive accumulation of
functionally incompetent lymphocytes
• a slow increase in the number of B
lymphocytes in the bone marrow
 CHRONIC LYMPHOCYTIC
LEUKEMIA(CLL) 2 : DIAGNOSTIC
TESTS
• CBC
• Flow cytometry
• Bone marrow aspiration
• Serum protein electrophoresis
• Staging
-Rai system (0 to 5)
-Binet system (a to c)
 CHRONIC LYMPHOCYTIC
LEUKEMIA(CLL) 3: ETIOLOGY
• Unknown
 CHRONIC LYMPHOCYTIC
LEUKEMIA(CLL) 4:
PATHOPHYSIOLOGY
• Formation of immature WBC’s
• Production of fewer WBC’s
• Multiplication and infiltration of
immature cells causes damage to bone
marrow and other structures
• Normal bone marrow is replaced by
abnormal or immature WBC
 CHRONIC LYMPHOCYTIC
LEUKEMIA(CLL) 5:SIGNS AND
SYMPTOMS
• Enlarged lymph nodes, liver, or spleen
• Fatigue
• Abnormal bruising (occurs late in the
disease)
• Excessive sweating, night sweats
• Loss of appetite
• Unintentional weight loss
 CHRONIC LYMPHOCYTIC
LEUKEMIA(CLL) 5:NURSING
MANAGEMENT
• ASSESSMENT
• DIAGNOSIS
• PLANNING
• INTERVENTION
• EVALUATION
 ALL and CLL: PROCEDURES
A bone marrow biopsy is the removal
of soft tissue from inside bone
• The skin is cleansed
• A local anesthetic is injected
• The biopsy needle is then inserted into
the bone
• The core of the needle is removed by
rotating the needle or inserting an
instrument within the needle
ALL and CLL: PROCEDURES 2
• This forces a tiny sample of the bone
marrow into the needle
• The needle is then removed
• Pressure is applied to the biopsy site to
stop bleeding, and a bandage is applied
ALL and CLL: PROCEDURES 3
Lymph node biopsy is the removal of a
lymph node or a piece of a lymph node
for examination under a microscope
There are two ways the sample may be
obtained:
• Needle biopsy: a needle is inserted into
a node to obtain the sample
• Open biopsy: consists of surgically
removing all or part of a node
 ACUTE MYELOID LEUKEMIA:
DESCRIPTION
• Acute myeloid leukemia (AML) is cancer that
starts inside bone marrow
• There is an accumulation and proliferation of
immature granulocytes (myeloblasts) in the
bone marrow which interfere with the
production of normal blood cells
• One of the most common types of leukemia
among adults
• AML is more common in men than women
 ACUTE MYELOID LEUKEMIA 2:
DIAGNOSTIC TESTS
• CBC
• Bone Marrow Aspirate
• Bone Marrow Biopsy
 ACUTE MYELOID LEUKEMIA 3:
ETIOLOGY
• Mostly unknown
Possible causes:
• Radiation
• Certain chemicals (for example,
benzene)
• Certain chemotherapy drugs
• Several congenital Disorders
 ACUTE MYELOID LEUKEMIA 4:
ETIOLOGY
• Blood disorders, including:
-Polycythemia vera
-Essential thrombocythemia
-Myelodysplasia (refractory anemia)
• Genetic factors
 ACUTE MYELOID LEUKEMIA 5:
PATHOPHYSIOLOGY
• A single myeloblast accumulates genetic
changes
• The cell remains in its immature state and
does not differentiate
• Other mutations which disrupt genes
controlling proliferation occurs
• The result is the uncontrolled growth of an
immature clone of cells
• The uncontrolled proliferation tends to
displace or interfere with the development of
normal blood cells in the bone marrow
 ACUTE MYELOID LEUKEMIA 6:
SIGNS AND SYMPTOMS
• Abnormal menstrual periods
• Bleeding from the nose
• Bleeding gums
• Bruising
• Bone pain or tenderness
• Fatigue
 ACUTE MYELOID LEUKEMIA 7:
SIGNS AND SYMPTOMS
• Fever
• Paleness
• Shortness of breath (gets worse with
exercise)
• Skin rash or lesion
• Swollen gums (rare)
• Weight loss
 ACUTE MYELOID LEUKEMIA 8:
TREATMENT
• Chemotherapy
• Antibiotics to treat infection
• Transfusions of platelets to control
bleeding
• Red blood cell transfusions to fight
anemia
• Bone marrow transplant or stem cell
transplant
 CHRONIC MYLOID LEUKEMIA:
DESCRIPTION
• Chronic myeloid leukemia (CML) is a
form of leukemia characterized by the
increased and unregulated growth of
predominantly myeloid cells in the
bone marrow and the accumulation of
these cells in the blood
 CHRONIC MYLOID LEUKEMIA 2:
DIAGNOSTIC TEST
• CBC
• CBC differential
• Bone Marrow Aspirate
• Bone Marrow Biopsy
• Testing for the presence of the
Philadelphia chromosome
CHRONIC MYLOID LEUKEMIA 3:
ETIOLOGY
• Chromosome abnormality called the
Philadelphia chromosome
• Radiation
• Previous cancer treatment
CHRONIC MYLOID LEUKEMIA 4:
PATHOPYSIOLOGY
• A single myeloblast accumulates
genetic changes
• The cell remains in its immature state
and does not differentiate
• Other mutations which disrupt genes
controlling proliferation occurs
• The result is the uncontrolled growth of
an immature clone of cells
CHRONIC MYLOID LEUKEMIA 5:
SIGNS AND SYMPTOMS
• Chronic phase that can last for months
or years: few or none
• Accelerated phase:
-fever (without infection)
-bone pain
-a swollen spleen
CHRONIC MYLOID LEUKEMIA 6:
SIGNS AND SYMPTOMS
• Blast crisis phase:
-bleeding
-infection
 CHRONIC MYLOID LEUKEMIA 7:
SIGNS AND SYMPTOMS
Other possible symptoms include:
• Fatigue
• Weakness
• Excessive sweating (night sweats)
• Low-grade fever
CHRONIC MYLOID LEUKEMIA 8:
SIGNS AND SYMPTOMS
• Pressure under the left ribs from an
swollen spleen
• Bleeding and bruising
• Sudden appearance of small red marks
on the skin (petechiae)
CHRONIC MYLOID LEUKEMIA 9 :
TREATMENT
• Chemotherapy
• Bone marrow transplant
 NURSING MANAGEMENT OF
AML & CML
• ASSESSMENT
• DIAGNOSIS
• PLANNING
• INTERVENTIONS
• EVALUATION
 LYMPHOMA: DESCRIPTION
Lymphoma is cancer of the lymphatic
system
• Two types:
-Hodgkins disease: a malignant
disorder of the lymph nodes
characterized by the presence of Reed-
Sternberg cells
LYMPHOMA 2: DESCRIPTION
-Non-Hodgkins lymphoma: a broad group
of neoplastic disorders that affect the
lymphatic system
 HODGKINS LYMPHOMA:
DESCRIPTION
• Hodgkin's lymphoma, also known as
Hodgkin's disease, is a type of
lymphoma by the orderly spread of
disease from one lymph node group to
another and by the development of
systemic symptoms with advanced
disease
 HODGKINS LYMPHOMA 3:
DIAGNOSTIC TESTS
• Lymph node biopsy
• Other procedures that may be valuable
in evaluating Hodgkin's disease
include:
• X-ray
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
 HODGKINS LYMPHOMA 4:
DIAGNOSTIC TESTS
• Gallium scan
• Positron emission tomography (PET)
scan
• Bone marrow biopsy
• Blood tests
 HODGKINS LYMPHOMA 5:
ETIOLOGY
• UNKNOWN
 HODGKINS LYMPHOMA 6:
PATHOPHYSIOLOGY
• Reed-Stenberg cells replace normal
cellular structure
• These cells originate in one lymph
node and then spreads to adjacent
system through the lymph system
• Eventually infiltrates other tissues
including liver, spleen, lungs, bone
marrow and ureters
HODGKINS LYMPHOMA 7: SIGNS
AND SYMPTOMS
• Painless swelling of the lymph nodes in the
neck, armpits, or groin
• Fatigue
• Fever and chills
• Night sweats
• Weight loss
• Loss of appetite
• Generalized itching
HODGKINS LYMPHOMA 8: SIGNS
AND SYMPTOMS
Additional symptoms that may be associated
with this disease:
• Excessive sweating
• Skin blushing or flushing
• Neck pain
• Hair loss
• Flank pain
• Clubbing of the fingers or toes
• Splenomegaly
 HODGKINS LYMPHOMA 9:
TREATMENT
A staging evaluation is necessary to
determine the treatment plan.
• Stage I indicates one lymph node
region is involved (for example, the
right neck)
• Stage II indicates involvement of 2
lymph nodes on the same side of the
diaphragm (for example, both sides of
the neck)
 HODGKINS LYMPHOMA 10:
TREATMENT
• Stage III indicates lymph node
involvement on both sides of the
diaphragm (for example, groin and
armpit)
• Stage IV involves the spread of cancer
outside the lymph nodes (for example,
to bone marrow, lungs, or liver)
 HODGKINS LYMPHOMA 11:
TREATMENT
Stages I and II (limited disease) can be
treated with:
• localized radiation therapy
• chemotherapy
• a combination of both
 HODGKINS LYMPHOMA 12:
TREATMENT
Stages III and IV (extensive disease) are
treated with:
• chemotherapy alone or
• a combination of radiation therapy and
chemotherapy
 HODGKINS LYMPHOMA:
NURSING MANAGEMENT
• ASSESSMENT
• DIAGNOSIS
• PLANNING
• INTERVENTIONS
• EVALUATION
 NON-HODGKINS LYMPHOMA:
DESCRIPTION
• Non-Hodgkin’s lymphoma (NHL):
cancer that affects the lymphatic
system
• Non-Hodgkin’s disease causes the
lymphatic system to abnormally
produce an increased number of white
blood cells (lymphocytes) which can
then cause tumors to develop and grow
 NON-HODGKINS LYMPHOMA 2:
DESCRIPTION
• In addition to causing tumors to
develop, Non-Hodgkin’s lymphoma
cells can also spread and affect other
lymphatic system elements including:
lymphatic vessels, tonsils, adenoids,
spleen, thymus, and bone marrow
 NON-HODGKINS LYMPHOMA 3:
DIAGNOSTIC TESTS
• Biopsies
• Blood and urine tests
• X-Ray
• Computer Tomography (CT)
• Positron Emission Tomography (PET)
• Bone Marrow Tests
• Lumbar Puncture
NON-HODGKINS LYMPHOMA 4:
ETIOLOGY
• Largely Unknown
 NON-HODGKINS LYMPHOMA 5:
PATHOPHYSIOLOGY
• Cells that make up the lymphoid tissue
become abnormal and eventually
crowd out normal cells within specific
regions of the lymph nodes
• Lymphoma usually develops outside
lymph nodes and spreads rapidly
 NON-HODGKINS LYMPHOMA 6:
SIGNS AND SYMPTOMS
• Painless lymph node enlargement:
-unilateral
-bilateral
-cervical first
-axillary second
-inguinal easily assessable
 NON-HODGKINS LYMPHOMA 7:
SIGNS AND SYMPTOMS
More advanced disease
• Weight loss
• Night sweats
• Malaise
• Chills
• Pruritis
 NON-HODGKINS LYMPHOMA 8:
SIGNS AND SYMPTOMS
• Anorexia
• Non-productive cough
• Dysnea
• Renal failure
 NON-HODGKINS LYMPHOMA 9:
TREATMENT
• Chemotherapy
• Radiotherapy
• Stem-Cell Transplantation
• Biologic Therapy
• Radioimmunotherapy
 NON-HODGKINS LYMPHOMA:
NURSING MANAGEMENT
• ASSESSMENT
• DIAGNOSIS
• PLANNING
• INTERVENTIONS
• EVALUATION
 IN CLASS GROUP ACTIVITY
• Justin is eight (8) years old and was admitted to
hospital with a chief complaint of persistent fever of
unknown origin for the last five (5) days. Physical
examination and blood tests reveal that he has Acute
Lymphocytic Leukemia.
Discuss the nursing management of Justin with
specific reference to
(a) The emotional needs of Justin and his family
(b) The supportive care in the early stages of the
disease
© Detecting and controlling hemorrhaging
To be done by teams 1 and 3
 IN CLASS GROUP ACTIVITY
• You are caring for a thirty eight (38) year old
male (Curtis) who has recently been diagnosed
with Chronic Mylocytic Leukemia. He was
started on chemotherapy two days ago.
Discuss the management of this patient with
reference to
(a) preventing and treating infections
(b) pain and comfort needs
© the patient coping with the disease
To be done by teams 2 and 5
 IN CLASS GROUP ACTIVITY
• Mr. Thompson is a 55yr old patient diagnosed
with Non-Hodgkins Lymphoma. He is presently
having chemotherapy.
Discuss the management of this patient with
reference to
(a) Nutritional needs
(b) Rest and sleep
© Health teaching
To be done by teams 4 and 6