MCNP NCM 101

LEUKEMIA - A MALIGNANT DISEASE OF THE BLOOD FORMING ORGANS (BONE MARROW, SPLEEN, LYMPH SYSTEM) - ACCOUNTS FOR 8% OF ALL HUMAN CANCERS - MOST COMMON MALIGNANCY IN CHILDREN AND YOUNG ADULTS ETIOLOGY: UNKNOWN RISK FACTORS: - GENETIC FACTORS - CONGENITAL ABNORMALITY (DOWN SYNDROME) - EXPOSURE TO RADIATION AND CHEMICALS - INFECTION WITH HUMAN T-CELL LEUKEMIA VIRUS TYPE ACUTE LEUKEMIA - LEUKEMIC CELLS ARE PRIMITIVE(IMMATURE WBC!") - CAUSED BY NEOPLASTIC PROLIFERATION OF LARGE NUMBER OF ABNORMAL AND IMMATURE LEUKOCYTES # MA$OR FORMS OF ACUTE LEUKEMIA A% ACUTE LYMPHOTIC LEUKEMIA (ALL) - CAUSED BY THE MALIGNANT PLORIFERATION OF PRECURSOR LYMPHOCYTES(LYMPHOBLASTS) - ACCOUNTS &'% OF ACUTE LEUKEMIA - COMMON IN CHILDREN B% ACUTE NON-LYMPHOTIC LEUKEMIA (ANLL) - FORMERLY KNOWN AS ACUTE MYELOGENOUS LEUKEMIA(AML) - CHARACTERI(ED BY ABBERATIONS IN THE GROWTH OF MEGAKARYOCYTES, MONOCYUTES, GRANULOCYTES AND ERYTHROCYTES - COMMON IN ADULTS CHRONIC LEUKEMIA - HAS A GRADUAL ONSET - THE WBC!" PRODUCED ARE MORE MATURE THAN ACUTE THUS CAN BETTER DEFEND THE BODY AGAINST INVADING MICROORGANISM # MA$OR FORMS OF CHRONIC LEUKEMIA A% CHRONIC LYMPHOCYTIC LEUKEMIA - CAUSED BY PROLIFERATION OF EARLY B LYMPHOCYTES - EARLY B LYMPHOCYTES ARE ABNORMAL AND INCOMPETENT LYMPHOCYTES PROLIFERATE AND ACCUMULATE IN THE LYMPH NODES AND SPLEEN BUT MOST OF THE CIRCULATING CELLS ARE MATURE LYMPHOCYTES THE ONLY LEUKEMIA WITH A POSSIBLKE GENETIC PREDISPOSITION - MOST BENIGN AND SLOWEST IN PROGRESSION - COMMON IN ELDERLY B% CHRONIC MYELOGENOUS LEUKEMIA - THERE IS UNCONTROLLED PROLIFERATION(LIVER AND SPLEEN) OF GRANULOCYTES RESULTING IN INCREASED IMMATURE CIRCULATING CELLS - COMMON IN MIDDLE AGED GROUP

PATHOPHYSIOLOGY IMMATURE CELLS UNDERGO AN ABNORMAL TRANSFORMATION GIVING RISE TO LEUKEMIC CELLS LEUKEMIC CELLS MULTIPLY, PROLIFERATES AND ACCUMULATE - SPLENOMEGALY - HEPATOMEGALY - CNS HEADACHE - LYMPHADENOPATHY - BONE PAIN - RENAL INSUFICIENCY

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MCNP NCM 101 - ARTHRALGIA DECREASED PRODUCTION OF NORMAL CELLS PANCYTOPENIA - DECREASED RBC, WBC, PLATELETS
CLINICAL MANIFESTATIONS - SIGNS AND SYMPTOMS OF ANEMIA, THROBOCYTOPENIA, LEUKOPENIA - FEELING OF ABDOMINAL FULLNESS AND EARLY SATIETY A SIGN OF SPLENOMEGALY DIAGNOSTIC PROCEDURES - CBC ) REVEALS DECREASED RBC, PLATELETS - NORMAL, ABNORMALLY LOW, OR EXTREMELY HIGH WBC - BONE MARROW ASPIRATION ) REVEALS INCREASED IN IMMATURE WBC!" - LUMBAR PUNCTURE ) REVEALS PRESENCE OF BLAST CELLS MEDICAL MNGT: - CHEMOTHERAPY - GIVE ALLOPURINOL TO INHIBIT URIC ACID FORMATION - RADIATION THERAPHY - FILGRASTIM ) A COLONY STIMULATING FACTOR THAT SPUR THE GROWTH OF GRANULOCYTES, RBC, PLATELETS SURGICAL MNGT: - SPLENOMEGALY ) FRO SEVERE SPLENOMEGALY NX INTERVENTIONS - NURSING DIAGNOSIS: - HIGH RISK FOR INFECTION - GOOD HAND WASHING TECHNI*UE - PRIVATE ROOM WITH REVERSE ISOLATION - AVOID RAW VEGETABLES AND FRUITS - AVOID FLOWERS AND PLANTS IN THE CLIENTS ROOM - NOTIFY DOCTOR IF BODY TEMPERATURE IS ABOVE +8 OC - LIMIT VISITORS - AVOID CROWDS - HIGH RISK FOR BLEEDING o w/o s/sx ogf !""#$%g g&'s ( &s" sof)* *oo*+ ,&s+ -o%s*$./*$o% ( s*oo! sof*"%",s0 s&..os$*o,$"s0 s/f"*) MULTIPLE MYOLOMA - I" , -,./01,123 45 678 9.,"-, B 28.." 67,6 /15/.6:,68" 678 ;418 -,::4< 67:4=074=6 678 ;418" - L8,>" 64 678 >8"6:=26/41 45 4678: ;418 -,::4< 28..", >8"6:=26/41 45 678 ;418 24:68? ,1> 678 "82:86/41 ;3 678 28.." 45 678 -4142.41,. 9,:,9:468/1(BENCE-$ONES) - I1 .,68: "6,08" /6 /15/.6:,68" 678 ./@8:, .3-97 14>8", .=10", "9.881, ,>:81,. 0.,1>", A/>183, "A/1 ,1> GI 6:,26 - M4:8 24--41 /1 -81 ,568: ,08 B' 98,A" ,6 ,08 C' CAUSE: =1A14<1 RISK FACTORS: - I41/D/10 :,>/,6/41 8?94"=:8 - E?94"=:8 64 28:6,/1 278-/2,." - F,-/.3 7/"64:3

PATHOPHYSIOLOGY B lymp !"y#$% T&'(% )(#! m*l)+(*(# pl*%m* "$ll% P'!,&"$ *(, '$l$*%$ &+$ *m!&(# !- I+G, I+A, BENCE-.ONES p*'*p'!#$)( lhieanne_zedlac

MCNP NCM 101

A/(!'m*l *(, $0"$%%)1$ *m!&(#% !Cy#!3)($% *'$ p'!,&"$, Ly#)" l$%)!(% *(, ,)--&%$ O%#$!p!'!%)% P*# !l!+)" -'*"#&'$% 4 %$'&m C*

*""&m&l*#)!( )( # $ m*''!2 D)%'&p#% RBC, WBC, Pl*#$l$# p'!,&"#)!( P*("y#!p$()*

SIGNS AND SYMPTOMS: - C41"6,16 "8@8:8 ;418 9,/1 <4:"818> ;3 -4@8-816 - H398:@/"24"/63 >E6 /12:8,"8> "8:=- C, - H8,>,278 - SA8.86,. >854:-/6/8" >E6 ;418 >8-/18:,./D,6/41 - L4"" 45 78/076 >E6 4"68494:4"/" - R81,. >3"5=126/41 >E6 4;"6:=26/41 45 241@4.=68> 6=;=.8" ;3 24,0=.,68> 9:468/1 9,:6/2.8" COMPLICATIONS: - R81,. "6418" >E6 7398:=:/28-/, - S9/1,. 24:> 24-9:8""/41 - C,:9,. 6=118. "31>:4-8 - I15826/41 - B.88>/10 DIAGNOSTIC PROCEDURES - X-RAY ) >/55="8 ;418 .8"/41" - 4"684.36/2 .8"/41" - </>8"9:8,> >8-/18:,./D,6/41 - 4"68494:4"/" - B418 M,::4< A"9/:,6/41 ) /12:8,"8 /--,6=:8 ,1> ,;14:-,. 9.,"-, 28.." - >89.86/41 45 RBC, WBC, F P.,68.86" CBC - G H0;, G WBC, G P.,68.86 - H "8:=- C,, H"8:=- 0.4;=./1", H ESR UEA ) (I)BENCE-$ONES 9:468/1 2415/:-" 678 >/"8,"8 - 7398:2,.2/=:/,

MEDICAL MANAGEMENT - C78-4678:,93 ) -8.97,.,1 ,1> 9:8>1/"418, 2364?,1 - R,>/,6/41 678:,93 - T:,1"5="/41 678:,93 - P.,"-,978:8"/" ) :8-4@8" BENCE-$ONES 9:468/1" 5:4- </67>:,<1 ;.44> ,1> :86:,1"5="8" 678 28.." 64 678 9,6/816 - A1,.08"/2" 54: ;418 9,/1 - C4:6/24"68:4/>" ,1> -/67:,-32/1 54: "8@8:8 7398:2,.28-/, - S644. "456818:" - A16/;/46/2" 64 6:8,6 /15826/41" - G,--,0.4;=./1 54: /15826/41 9:4973.,?/"(P,-/>:41,68 N, - A:8>/,) - I168:58:41 A.5, ) 64 9:4.410 >=:,6/41 45 :8-/""/41 NURSING MANAGEMENT - P:4-468 ",5863 9,6/816 /" 9:418 64 9,674.40/2 5:,26=:8" - H 5.=/> /16,A8 +-B LE>,3 ) 64 >/.=68 2,.2/=- 4@8:.4,> ,1> 9:8@816 9:468/1 5:4- 9:82/9/6,6/10 /1 :81,. 6=;=.8" - S-,.. 5:8J=816 588>/10" - M41/64: I F O ,1> ;.44> "6=>/8" - E124=:,08 ,-;=.,6/41 64 ".4< >8-/18:,./D,6/41 - N=:"/10 /168:@816/41" 54: ,18-/,, 67:4-;42364981/,, .8=24981/,

DISORDERS OF PLATELET AND CLOTTING FACTORS AND MANAGEMENT Normal clot formation and lysis depends on: 1. intact blood vessel

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MCNP NCM 101

2. adequate number of function of platelet 3. sufficient amount of clotting factors 4. ell!controlled fibrinolytic system "roblems underlying hemorrhagic disorders are due to the follo ing: 1. ea#$ damage blood vessel that rupture easily or spontaneously 2. platelet deficiency 3. deficiency or total lac# of one of the clotting factors 4. e%cessive&insufficient fibrinolysis NURSING MANAGEMENT FOR PLATELET DISORDERS - C416:4. B.88>/10 R ) :8"6 I ) /--4;/./D8 64 9:8@816 67:4-;=" 64 ;8 8-;4./ C ) 24.> 24-9:8"", /28 ;,0 ,99./2,6/41, >/:826 24-9:8""/41 4: 9:8""=:8 E ) 8.8@,68 ,;4@8 78,:6 .8@8. - W,627 4=6 54: ,/:<,3 4;"6:=26/41 >E6 ;.88>/10 /1 678 182A F 97,:31? - M41/64: ;.44> .4"" ,1> J=,16/53 - O;"8:@8 54: "/01" 45 ,>>/6/41,. ;.88>/10 4: 67:4-;=" 54:-,6/41 - W,627 4=6 54: 7394@4.8-/2 "742A - G BP, H PR, H RR, G BT - M41/64: ,99:49:/,68 .,; >,6, ) P.,68.86 24=16( K'-B''K), BT( -B-/1), PT( - C"82), PTT(C'L'"82), ,PTT(+'-B'"82) - A>-/1/"68: -8>/2,6/41" 4:,..3, :826,..3, 4: IV :,678: 67,1 IM - A@4/> :826,. 68-98:,6=:8 -41/64:/10 - U"8 "644. "456818:" 64 9:8@816 "6:,/1/10 - T=:1 ,1> :894"/6/41 2./816 5:8J=816.3 ,1> 0816.3 SAFETY PRECAUTIONS (CHILD PROOFING AND HIS ENVIRONMENT) - P,> 2:/; ,1> 9.,3981 - P:4@/>8 "456 643" - S8< 9,>" /1 A188" ,1> 8.;4<" 45 2.467/10 - P:46826/@8 78,>08,: >=:/10 64>>.8:744> HEALTH TEACHINGS - A@4/> ,"9/:/1 - U"8 "456 ;:/"6.8> 64467;:="7, 246641 "<,;", 0,=D8 - A@4/> 2416,26 "94:6" "=27 ," "4228:, ;,"A86;,.., <:8"6./10, "=008"6 "</--/10, 04.5, 944. - U"8 8.826:/2 :,D4:" I. IDIOPATHIC THROMBOCYTOPENIA PURPURA (ITP) - most common thrombocytopenic disorder - hemorrhagic autoimmune disease that results in the destruction of platelets - most common in childhood follo ing viral illness - increase incidence in omen Patho: antibodies of both 'g( ) 'g* subclasses against platelet associated antigen destruction of platelets in spleen and liver s&s%: petechiae ecchymosis epista%is bleeding from gums easy bruising omen may have e%tremely heavy menses

+% ,est: - "latelet : - 1..$...&mm3 - "rolonged bleeding time ith normal coagulation time - 'ncrease capillary fragility as demonstrated by tourniquet test

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MCNP NCM 101

*ngt: /01 "latelet antibody test 2one marro aspirate 3 contain normal or increased 4 of mega#aryote *edical *ngt

5orticosteroids 6 inhibit the macrophage ingestion of the anti!body coated platelet /01 7ctive bleeding 6 '8 gammaglobulin increases platelet count 'mmunosuppressive therapy "lasmapheresis /short!term1

Nursing *ngt N% +iagnosis: 9is# for 'n:ury r&t bleeding s&t thrombocytopenia 7ssessment: 2leeding episodes 2leeding "recautions: o "romote safety&decrease ris# for in:ury o 7void sharps o +emonstrate use of direct&steady pressure at bleeding site o "revent '*&;5 in:ections o 2e careful in using razors

II. DISSEMINATED INTRAVASCULAR COAGULATION (DIC) - comple% syndrome of activated coagulation that results in bleeding and thrombosis - loss of balance bet een clotting and lysing systems in the body 'ncrease ,<9=*2'N 3 thrombosis 'ncrease ">7;*'N 3 triggers e%cessive clot lysis /FIBRINOLYSIS1 6 bleeding - +'5 is a contradictory states of e%cessive thrombosis and lysis simultaneously ?tiology&9is# @actors: - 5ategories 'nfection 6 (ram /!1 streptococcus 'ntroduction of tissue coagulation factor into the circulation 9elease of thromboplastin o neoplastic gro th o abruption placenta o eclampsia o dead fetus o septicemia o retained&dead fetus +amage to vascular endothelium trauma heat stro#e burns ;tagnant blood flo prolonged immobility Patho: precipitating mechanisms e%trinsic coagulation path ays /trauma1 intrinsic coagulation path ays /damage to blood vessel1

'N,9787;5A>79 5=7(A>7,'=N /production of microthrombi&release of thromboplastic substances1 production of thrombi activation of fibrinoltyic systems activation of fibrinolytic systems consumption of clotting factors occlusion of small blood vessel /brain$ #idneys$ heart$ other organs1 tissue necrosis 7 7

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MCNP NCM 101

digestion of fibrin clot inhibition of platelet function 2>??+'N( s&s%: -

decrease 4 of clotting factors

thrombosytopenia

<?*=99<7('5 purpura$ petechiae$ ecchymoses sever uncontrolled hemorrhage during surgey&childbirth prolonged bleeding from venipunctue site tachycardia$ hypotension intracerebral&(' bleeding renal hematuria e%cessive bleeding from gums&nose dyspnes$ heoptysis$ respiratory congestion - *'59=87;5A>79 ,<9=*2=;'; acute respiratory distress&acute respiratory failure convulsion&coma ischemia of peripheral tissue /7597> 5B7N=;';1 delirium hemorrhagic necrosis oliguria pulmonary embolism +% ,est: - "latelet count 6 diminished - ",$ ",, and thrombin time 6 prolonged - @ibrinogen 6 decreased level - @ibrin split /degradation1 products 6 increased level - +!dimer fibrin degradation product 6 increased level - 7ntithrombin ''' ! decreased level - "rotein 5 6 decreased level *ngt: *edical *ngt: 'dentification and correction of precipitating cause ?.g. 'nfection ! antibiotics 2lood replacement fresh frozen plasma 6 replaces clotting factors platelet transfusions cryoprecipitate 6 replaces clotting factors and fibrinogen "rovision of supportive therapy fluid replacement o%ygen maintenance of 2" and renal perfusion heparin Nursing *ngt: Nursing +iagnosis: 9is# for 'n:ury r&t bleeding s&t thrombocytopenia 'neffective tissue perfusion r&t ischemia s&t microthrombi formation *inimizing 2leeding 2leeding precautions *onitor blood loss 7dminister blood products as ordered /monitor reactions1 7void dislodging clotsCapply pressure to bleeding sites 6 at least 2. mins. *aintain bedrest during bleeding episodes 7ssess internal bleeding /e.g. hematuria&melena1 ?valuate fluid status and bleeding /8;$ 58"$ '&=1 "romoting ,issue "erfusion Deep patient arm 7void vasoconstrictive agents

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MCNP NCM 101

5hange position frequently&perform 9=* *onitor ?5(&lab test /arrhythmias$ 72($ 2AN$ creatinine1 *onitor s&s% of vascular occlusion and report 7;7" o 2rain 6 decreased >=5$ sensory&motor deficits$ seizure$ coma o ?yes 6 visual deficits o 2one 6 bone pain o "ulmonary vasculature 6 chest pain$tachycardia$ ;=2 o ?%tremeties 6 cold$ mottling$ numbness o 5oronary arteries 6 chest pain$ arrhythmias o 2o el 6 pain$ tenderness$ decreased bo el sounds III. HEMOPHILIA - E!lin#ed genetic disorder that result in the deficiency of coagulation factors Patho: @actor 8''' and 'E deficiency 'nsufficient production of thrombi through intrinsic coagulation path ay 5reates profound tendency of spontaneous bleeding <emophilia 7 <emophilia 2 s&s%: 'nherited @actor 8''' deficiency 'nherited @actor 8''' deficiency /"lasma ,hromboplastin 5omponent1 2oth are ,ransmitted as se%!in#ed recessive trait$ transmitted by females occurs in males

<allmar#: <?*79,<9=;'; 6 bleeding in the :oints "ainful and leads to deterioration of the :oints slo persistent bleeding delayed hemorrhage severe hemorrhage /e.g in gums$ during dental e%traction1 severe&fatal epista%is gastric hemorrhage recurrent hematoma hematuria splenic rupture intracranial bleeding

+% test: - 5oagulation time 6 prolonged - @actors 8''' ) 'E 6 generally decreased - 7",, 6 prolonged - Fuantitative assay for @actor 8''' determines severity *ngt: *edical *ngt

Nursing *ngt

stop topical bleeding supply missing factor causing hemorrhage replacement therapy initiated as ordered o e.g.@actor 8'' ) 'E concentratesupplied as lyophilized po der prevent complication leads to and caused by bleeding for <emarthrosis 6 7nalgesic and 5orticosteroids Nursing +iagnosis: 9is# for 'n:ury r&t bleeding s&t decrease level of clotting factor 8''' *inimizing bleeding 7void use of razor$ hard toothbrush or floss 7void '* in:ections$ tourniquet$ rectal procedures$ suppository 7dminister stool softeners "9N to prevent constipation 9estrict activity and e%ercise hen platelet count -2.$...&mm 3 or hen active bleeding occurs *onitor bleeding episodes

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MCNP NCM 101

7dminister blood products as ordered Nice to Know: CLOTTING FACTORS ' 6 @'29'N=(?N '' 6 "9=,<9=*2'N ''' 6 ,';;A? ">7;*'N=(?N '8 6 57>5'A* '=N; 8 ! >72'>? @75,=9 8'' 6 ;,72>? @75,=9 8''' 6 7N,'<?*="<'>'5 @75,=9; 'E 6 5<9';,*7; @75,=9 /">7;*7 ,<9=*2=">7;,'N 5=*"=N?N, ",51 E 6 ;,A79, "=G?9 @75,=9 E' 6 ">7;*7 ,<9=*2=">7;,'N 7N,?5?+?N, E'' 6 <7(?*7N @75,=9 E''' 6 @'29'N ;,72'>'H'N( @75,=9

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