I.

Introduction

I personally selected this case of Acute Myelogenous Leukemia (AML) to enhance my

knowledge concerning its clinical manifestations, possible causes, cure and prevention, among
others. This knowledge will eventually become an indispensable tool that can be shared to others
and will never go out of style. It is a privilege to embrace this challenge in the form of service to
humanity and the fulfillment of our nursing profession. Our core competence is the bare essential
towards its success.
As a nursing profession, it is imperative to learn new techniques in modern science in order
to develop skills that would benefit the medical world. This learning potential must be relayed to
posterity and develop new techniques, state -of –the- art technology that caters the modern man. In
the final analysis, the achievement of one’s endeavor may usher us to find the light we are seeking
for.
First of all what is leukemia? Leukemia is a cancer of the blood, and is characterized by
uncontrolled proliferation and accumulation of leukocytes (white blood cells). Most leukemic cells
never mature into functioning leukocytes. Where in the body is deprived of vital components of its
immune system. Also, the cells accumulate in the blood and in certain organs, forcing out healthy
cells and interfering with the function of that organ. There many different types of leukemia but the
four most important forms are derived from only two types of cells, lymphocytes and myelocytes.
Acute myelogenous leukemia is disorders of granulocytes. Granulocytes produced by bone marrow,
engulf and digest bacteria and other small particles. This generally appears suddenly with symptoms
like those of cold, and progresses rapidly. The lymph nodes, spleen and liver may become
infiltrated with leukocytes and enlarged. There is often bone pain, paleness due to anemia, a
tendency to bleed easily because of depleted platelets and high susceptibility to infections. The most
common causes of death, which occurs on the average within three months if without treatment, are
hemorrhaging and uncontrolled infections. Acute myelogenous leukemia occurs much less
frequently in children.
II. Objectives
General Objectives:
After 3 days of giving holistic care, the patient will be able to regain optimum level of
functioning and adopt coping skills in performing activities of daily living.
Specific Objectives:
After 8 hours of giving holistic nursing care, the patient will be able to:
1. establish rapport with the student nurse
2. explain reasons of hospitalization
3. state past medical history related to present condition
4. identify the precipitating and predisposing factors that can possibly lead to the occurrence of the
condition
5. discuss the management applied upon the occurrence of the disease
After 8 hours of giving holistic care, the student nurse will be able to:
1. establish rapport with the patient
2. present the patient’s personal history
3. assess the patient’s level of growth and development
4. show present profile of functional health patterns
5. discuss with the patient the different predisposing and precipitating factors
 6. identify the pathophysiology and rationale
7. construct a comprehensive nursing care plan appropriate for the patient
8. discuss different measures for home management

III. Nursing Assessment

1. Personal History
1.1 Patients Profile
Name: Ivorie Shyrille Cabas
Age: 14 years old
Sex: Female
Civil Status: Single
Religion: Roman Catholic
Date of Admission: September 15, 2009
Room No. : 208
Complaints: tonsillitis
Diagnosis: Acute Myelogenous Leukemia
Physician: Dr. Bueno
1.2Family and individual information, social and health history
Mr. Abella, Fernando, 50 yrs. Old, male, Filipino Roman Catholic, who is married and has four
children, all of which are still schooling. The patient works in a government office. The patient is always
exposed in petroleum products and paints. Mr. Abella is not hypertensive, diabetic and asthmatic. He is an
occasional drinker and a positive smoker which he consumes one pack per day. Mr. Abella was rushed in
the emergency room of Medical Centrum Dagupan Hospital because he fainted and was very pale. He also
complains of tonsillitis.

1.3. Level of growth and Development

Normal Development at Particular Stage
The patient belongs to the middle adulthood. The middle years, from 40 – 65, have been
called the years of stability and consolidation. For most people, it is a time when children have grown and
moved away or are moving away from home. Thus, partners generally have more time for and with each
other and time to pursue interests they may have deferred for years.
The middle adulthood, the individual makes lasting contributions through involvement with
others. During this period, personal and career achievements have often already been experienced. Many
middle adults find particular joy in assisting their children and other young people to become productive
and responsible adults. They may also begin to help aging parents. Using leisure time in satisfying and
creative ways is a challenge that, if met satisfactory, enables middle adults to prepare for retirement.
Men and women must adjust to inevitable biological changes. As in adolescence, middle
adults use considerable energy to adapt self concept and body image to physiological realities and changes
in physical appearance. High self-esteem, a favorable body image, and a positive attitude toward
physiological changes are fostered when adults engage in physical exercise, balanced diet, adequate sleep,
and good hygiene practices that promote vigorous, healthy bodies.
Physical Changes
 A number of changes take place during the middle years. At 40, most adults can function as they
did in their twenties. However during ages 40 – 65, many physical changes takes place. Both men and
women experience decreasing hormonal production during the middle years. The menopause refers to the
so called change of life in women, when menstruation ceases. It is said to have occurred when a woman has
not had a menstrual period within a year. The menopause usually occurs anywhere between ages 40 – 55.
The average is about 47 years. At this time, the ovaries decrease in activity until ovulation ceases.
Psychologically, the menopause can be anxiety- producing time, especially if the ability to bear children is
an integral part of woman’s self concept. The hair begins to thin and gray hair appears. Skin turgor and
moisture decrease, subcutaneous fat decreases and wrinkling occur. Fatty tissue is redistributed, resulting in
fat deposits in the abdominal area. Skeletal muscle bulk decreases at about age 60. Thinning of the
intervertebral disk causes a decrease in height of about 1 inch. Calcium loss from bone tissue is more
common among postmenopausal women. Muscle growth continues in proportion to use. Blood vessels lose
elasticity and become thicker. Visual acuity declines, often by the late forties, especially for near vision
(presbyopia). Auditory acuity for high- frequency sounds (presbycusis) also decreases, particularly in men.
Taste sensations also diminish. Metabolism slows, resulting in weight gain. Gradual decrease in tone of
large intestine may predispose the individual to constipation. Nephron units are lost during this time, and
glomerular filtration rate decreases. Hormonal changes take place in both men and women.
Cognitive Changes
The middle- aged adults’ cognitive and intellectual abilities change very little. Cognitive processes
include the action time, memory, perception, learning, problem solving, and creativity. Reaction time
during the middle years stays much the same or diminishes during the later part of the middle years.
Memory and problem solving are maintained through middle adulthood. Learning continuous and cab be
enhanced by increased motivation at this time in life.
Middle-aged adults are able to carry out all the strategies described in Piaget’s phase of
formal operations. The experiences of the professional, social, and personal life of middle-aged persons
will be reflected in their cognitive performance. Thus, approaches to problem solving and task completion
will vary considerably in middle-aged group. The middle-aged adult can “reflect on the past and current
experience and can imagine, anticipate, plan and hope”.
Changes in the cognitive function of middle adults are rare except with illness are trauma.
The middle adult can learn new skills and information. Some middle adults enter educational or vocational
programs to prepare themselves for entering the job market or changing jobs.
Moral Changes
During this stage, rules and laws are valued because they maintain social order worth preserving.
Morality is guided by higher principles of human conduct. Individuals appreciate the social purposes served
by laws. They believe laws should be derived from a democratic consensus. Individuals search their own
conscience for universal ethical principles. They do not make up their own rules but instead arrive at
abstract principles that all religions or moral authorities might view as compelling or fair. There is a
correlation between higher stages of reasoning and higher levels of moral behavior.
According to Kohlberg, the adult can move beyond the conventional level to the post
conventional level. Kohlberg believes that extensive experience of personal moral choice and responsibility
is required before people can reach the post conventional level. Kohlberg found that few of his subjects
achieved the highest level of moral reasoning.
Psychosocial Development
The psychosocial changes in the middle adult may involve expected events, such as marital
separation. This change may result in stress that can affect the middle adults’ over all level of health. In the
middle adult years, as children depart from the household, the family enters the post parental family stage.
Time and financial demands on the parents decrease, and the couple faces the task of redefining their own
relationship. According to Eriksons’ developmental theory, the primary developmental task of the middle
years is to achieve generativity. Generativity is the willingness to care for and guide others. If middle adults
fail to achieve generativity, Stagnation occurs. This is shown by excessive concern with themselves or
destructive behavior toward their children and community.
Spiritual Changes
 As man grows older he becomes more aware of the outside world. Some conform when they are
forced to do so, some are driven by self interests and will do only what they must do to get what they want
in return. They violate God’s law regularly, sinning more or less everyday with little remorse. Their
spiritual senses are not alert. They are ignorant of God and have no concept of holiness. But as man grows
older, he becomes more conscious of how important people really are. “Being good” is now important. He
thinks about how other people see him and how they must feel. He realizes that the world runs according to
rules. The desire to please other drives him and when he fails his first response is to justify himself. This
faith is based on the beliefs of the community.
In adult life many individuals develop a faith that is purely their own individual faith and
can deal with the paradoxes and ironies of human existence. A final stage of development finds some
individuals making a commitment to universal values, such as love and justice. The focus on the value of
experience and reflection and intellectual development finds a strong parallel in the importance given to the
rule of experience and reflection in spiritual growth.
Sexuality Changes
After the departure of their last child from the home, many couples recultivate their relationships
and find increased marital and sexual satisfaction during middle age. The onset of menopause and the
climacteric can affect the sexual satisfaction during the middle adult. Other factors influencing sexuality
during this period include work stress, diminished health of one or both partners, and the use of prescription
medications.
 Diagnostic Test Normal Value Result Significance

Hemoglobin 14-17.5gm/dL 6.77gm/dL Decreased: Anemia

Hematocrit 14-17.5 19.3 Increased:
Erythrocytosis
WBC 4.4-11.0 174,000
Band 3% 02%
Segmenter 56% 05% Increased: Infection
Basophil 0.3% -- Decreased:
Eosnophil 2.7% -- Decreased:
Lymphocyte 34% 07%
NORMAL
Monocyte 4% 61% NORMAL
Decreased: Immuno –
RBC 4.5-5.9 10 12/L 1.93 10 12/L deficiency
MCV 80-96fL 100fL Increased: Viral
infections
MCH 27.5-33.2pg Decreased: Anemia
35.1 pg Increased: Macrocytic
MCHC 33.4-35.5% Anemia
MPV -- Increased: :
RDW -- 35.0% Macrocytic Anemia
Platelet Count 150,000-450,000/cu
mm -- NORMAL
--
NORMAL
Reticulocyte 27,020/cu mm NORMAL
ESR 0.5-1.5%
Creatinine Serum 0.00-20.00mm/h Decreased: Acute
Potassium 0.7-1.5mg/dL Leukemia
ALT 3.6-5.0mmol/L
Sodium 11-66uL
137-145mmol/L --
Uric Acid -- NORMAL
2.5-7.5mg/L NORMAL
2.1 mg/dL Increased: Fever
3.0 mmol/L Decreased: Diarrhea
59 uL
134 mmol/L NORMAL
Decreased: Metabolic
11.9 mg/L Acidosis
Increased: Gout

Present Profile of the Functional Health Patterns

3.1 Health Perception Pattern
Before the patient was diagnosed with Acute Myelogenous Leukemia the patient describes
himself as a healthy individual. But as of now, he describes his condition as very poor due to his present
condition. In order for him to keep healthy, he must eat nutritious foods and must not over fatigue himself.
He follows the doctors order and take the medication as needed. The patient refuses to have chemotherapy
due to financial problems.
3.2 Nutritional Metabolic Pattern
 Before the patient was not admitted in the hospital, he likes to eat any kind of foods. But as
of now, the patient does not want to eat and he vomits all the time. The patient drinks alcohol mostly
everyday, he prefers to drink Tanduay and Emperador and occasionally The BAR. The patient also smokes
and can consume one pack per day. The patient takes vitamin supplements like Revicon and Everet.
According to the patient his weight had decreased from 180 pounds to 110 pounds.
3.3 Elimination Pattern
On the first week of his admission, the patient was having hematuria and melena. After the
following weeks, the patient’s foley bag catheter was already removed and the patient was having
no problems in urinating and defecating. The patient defecates once in a day.
3.4 Activity or Exercise Pattern
Before, the patient used to walk from his home to his office, but now even five steps he feels fatigue
and will have a difficulty in breathing. The patient was advised by the physician not to over fatigue himself
and he needs enough sleep and rest.
3.5 Cognitive or Perceptual Pattern
The patient cannot see from far objects. He wears eyeglasses so that he can see clearly. The patient
can hear well enough. The patient often times complains of fatigue and feels drowsy all the time. The
patient is able to read and write.
3.6 Sleep or rest Pattern
Before the patient’s hospitalization, he sleeps at 7: 00 pm to 6:00 in the morning, but now
because of his condition he sleeps most of the time. The patient has no problem in sleeping.
3.7 Self Perception Pattern
The patient is concerned about his illness. He is scared that he will die and might be far
away from his family. According to the patient, he wants to be free from Leukemia but it is too impossible
to happen, it needs some miracles. The patient describes himself as very religious especially with his
condition and he must need some faith to hold on to whatever circumstances might happen. His condition
made him different because unlike normal people he needs to wear a mask all the time.
3.8 Role Relationship Pattern
The patient prefers to speak Cebuano. He speaks clearly and fluently and he is able to
express himself freely. The patient lives with his family in Matab-ang Toledo City.
3.9 Coping or stress Tolerance Pattern
The patient and his wife both make the decision especially when it comes to health and
financial matters. He sometimes seeks help to his mother when it comes t o problem solving because he is
more comfortable in asking for assistance so that he can express his feelings. The patient is still working
but he will just go to work to punch in and leave.
3.10 Value or belief System
The patient is a Roman Catholic and God is very important to him. For him, God and his
family is his source of strength and meaning. The patient prays the rosary and attends mass every Sunday.
The patient wishes to go to Simala to pray for his condition. According to the patient, he just accepts what
Gods plan awaits him.

IV. Pathophysiology and Rationale

Anatomy and Physiology
The immune system defends the body from invading organisms that may cause disease. One
part of the immune system uses barriers to protect the body from foreign substances. These barriers
include the skin and the mucous membranes, which line all body cavities; and protective chemicals,
such as enzymes in saliva and tears that destroy bacteria. Another part of the immune system uses
 lymphocytes, specialized white blood cells that respond to specific types of foreign invaders. B
lymphocytes produce proteins called antibodies, which circulate in the blood and attack specific
disease-causing organisms. T lymphocytes attack invading organisms directly.

COMPONENTS OF THE IMMUNE SYSTEM

Macrophage Engulfing Bacterium

A macrophage, in yellow, engulfs and consumes a bacterium. Macrophages are large phagocytes,
cells that wander through the body consuming foreign particles such as dust, asbestos particles, and
bacteria. They help protect the body against infection.
White blood cells are the mainstay of the immune system. Some white blood cells, known as
macrophages, play a function in innate immunity by surrounding, ingesting, and destroying invading
bacteria and other foreign organisms in a process called phagocytosis (literally, “cell eating”), which is part
of the inflammatory reaction. Macrophages also play an important role in adaptive immunity in that they
attach to invading antigens and deliver them to be destroyed by other components of the adaptive immune
system.
LYMPHOCYTE
Lymphocytes are specialized white blood cells whose function is to identify and destroy invading
antigens. All lymphocytes begin as “stem cells” in the bone marrow, the soft tissue that fills most bone
cavities, but they mature in two different places. Some lymphocytes mature in the bone marrow and are
called B lymphocytes. B lymphocytes, or B cells, make antibodies, which circulate through the blood and
other body fluids, binding to antigens and helping to destroy them in humoral immune responses.
Other lymphocytes, called T lymphocytes, or T cells, mature in the thymus, a small glandular organ located
behind the breastbone. Some T lymphocytes, called cytotoxic (cell-poisoning) or killer T lymphocytes,
generate cell-mediated immune responses, directly destroying cells that have specific antigens on their
surface that are recognized by the killer T cells. Helper T lymphocytes, a second kind of T lymphocyte,
regulate the immune system by controlling the strength and quality of all immune responses.
Most contact between antigens and lymphocytes occurs in the lymphoid organs—the lymph nodes, spleen,
and tonsils, as well as specialized areas of the intestine and lungs (see Lymphatic System). Mature
lymphocytes constantly travel through the blood to the lymphoid organs and then back to the blood again.
This recirculation ensures that the body is continuously monitored for invading substances.

BONE MARROW

Bone Marrow, soft, pulpy tissue that fills the cavities of bones, occurring in two forms, red and
yellow. One of the largest tissues in the body, bone marrow accounts for 2 to 5 percent of an adult’s weight.
Red marrow, present in all bones at birth, serves as the blood manufacturing center. As an infant matures,
most of the red marrow in the shaft of long bones, such as the arm and leg bones, is gradually replaced by
yellow marrow. Yellow marrow is composed primarily of specialized fat cells.

STRUCTURE

Red marrow consists primarily of a loose, soft network of blood vessels and protein fibers
interspersed with developing blood cells. The blood vessels are termed the vascular component, and the
protein fibers and developing blood cells collectively are referred to as the stroma, or the extravascular
component. The protein fibers crisscross the marrow, forming a meshwork that supports the developing
blood cells clustered in the spaces between the fibers. Red marrow contains a rich blood supply. Arteries
transport blood containing oxygen and nutrients into the marrow, and veins remove blood containing
carbon dioxide and other wastes. The arteries and veins are connected by capillaries, blood vessels that
branch throughout the marrow. In various places, the capillaries balloon out, forming numerous thin, blood-
filled cavities. These cavities are called sinusoids, and they assist in blood-cell production.

Yellow marrow is so named because it is composed of yellow fat cells interspersed in a rich mesh
of connective tissue that also supports many blood vessels. While not usually actively involved in blood
formation, in an emergency yellow marrow is replaced by blood-forming red marrow when the body needs
more blood

MARROW FUNCTION

Red marrow produces all of the body’s blood cells—red blood cells, white blood cells, and
platelets. Red blood cells in the circulatory system transport oxygen to body tissues and carbon dioxide
away from tissues. White blood cells are critical for fighting bacteria and other foreign invaders of the body
.Platelets are essential for the formation of blood clots to heal wounds. Within red bone marrow, all blood
cells originate from a single type of cell, called a hematopoietic stem cell. Stimulated by hormones and
growth factors, these stem cells divide to produce immature, or progenitor blood cells. Most of these
progenitor cells remain in the stroma and rapidly undergo a series of cell divisions, producing either red
blood cells or white blood cells. At any one time, the stroma consists largely of progenitor cells in various
stages of development. At the appropriate developmental stage, the fresh, new cells squeeze through the
walls of the capillaries. From there, the cells leave the bone and enter the body’s circulatory system. Some
progenitor cells migrate to the sinusoids, where they produce platelets, which also travel to the circulatory
system via the capillaries. Although stem cells are relatively rare—about 1 in every 10,000 marrow cells is
a stem cell—they typically produce the forerunners of an estimated 2 million red cells per second and 2
billion platelets per day. However, if significant amounts of blood are lost or other conditions reduce the
supply of oxygen to tissues, the kidneys secrete the hormone erythropoietin. This hormone stimulates stem
cells to produce more red blood cells. To fight off infection, hormones collectively termed colony
stimulating growth factors are released by the immune system. These hormones stimulate the stem cells to
produce more infection-fighting white blood cells. And in severe cases, the body converts yellow marrow
into red marrow to help produce needed blood cells.

4.3 Disease process ands its effects on different organ/system

Leukemia Overview

Cancer is a process of uncontrolled abnormal cell growth and development. Under normal
circumstances, cells are formed, mature, carry out their intended function, and then die. New cells are
constantly regenerated in the body to replace those cells and to maintain normal cellular function. Cancer
represents the disturbance of this process, which can occur in several ways.Cells may grow and
reproduce in a disorganized and out-of-control fashion. Cells may fail to develop properly, so they will not
function normally. Cells may fail to die normally. One or a combination of these processes may occur when
cells become cancerous.

Leukemia is a cancer of blood-forming cells in the bone marrow. These deranged, immature cells
accumulate in the blood and within organs of the body. They are not able to carry out the normal functions
of blood cells.

Normal blood contains 3 major groups of cells: white blood cells, red blood cells, and platelets. All 3 types
of blood cells develop from one immature cell type, called blood/marrow stem cells, in a process called
hematopoiesis.

• These stem cells divide and develop to a more developed, but still immature precursor, called a
blast, which then develops through several more stages, into a mature blood cell.
• This process takes place in the bone marrow, which is the soft spongy material found in the center
of most bones.

Each type of blood cells has its own different and essential function in the body.
 • White blood cells (leukocytes) are part of the immune system and help fight a variety of infections.
They also help in the healing of wounds, cuts, and sores.
• Red blood cells (erythrocytes) contain hemoglobin, which carries oxygen to, and removes carbon
dioxide from, the cells throughout the various organs of the body.
• Platelets, along with certain plasma proteins, help plug the holes in blood vessels and form clots
once blood vessels are damaged or cut.

The first step in the process of stem cell maturation is differentiation into 2 groups: the myeloid stem cell
line and the lymphoid stem cell line.

• The myeloid stem cells, or lineage, develop into red blood cells, platelets, and certain types of white
blood cells (granulocytes or monocytes).
• The lymphoid stem cells, or lineage, develop into another type of white blood cell (lymphocytes).
• Either lineage can be affected by leukemia. Leukemias that affect the myeloid lineage are called
myelocytic (also myelogenous, myeloblastic, or nonlymphocytic) leukemias. Leukemias that affect
the lymphoid lineage are called lymphocytic (also lymphoblastic or lymphogenous) leukemias.

Each of the 2 major types of leukemia, myelogenous and lymphocytic, include both acute and chronic
forms.

• Acute essentially refers to a disorder of rapid onset. In the acute myelocytic leukemias, the
abnormal cells grow rapidly and do not mature. Most of these immature cells tend to die rapidly. In
the acute lymphocytic leukemias, growth is not as rapid as that of the myelocytic cells. Rather, the
cells tend to accumulate. Common to both types of leukemia is their inability to carry out the
functions of healthy white blood cells. Untreated, death occurs within weeks or a few months.
• In the chronic leukemias, the onset tends to be slow, and the cells generally mature abnormally and
often accumulate in various organs, often over long intervals. Their ability to fight infections and
assist in repairing injured tissues is impaired. However, unlike the acute forms of leukemia,
untreated, these disorders may persist for many months or, as in the chronic lymphocytic group,
many years. A distinctive feature of the chronic myelocytic type is its invariable conversion, if
untreated, to a more rapidly fulminating acute type, leading to rapid death.

WHAT HAPPENS IN LEUKEMIA?

When a large number of blasts (leukemic cells) appear in the bone marrow, several things
happen. As the leukemic blast cells accumulate in the bone marrow, they begin to crowd out the
normal blood cells that develop there. Eventually, they take up so much room that red blood cells,
platelets, and normal white blood cells cannot be produced. When that happens, the young person
develops symptoms indicating that normal blood cells are not being manufactured in adequate
numbers:

• If red blood cells are crowded out by leukemic cells, the blood will look thin, which makes the
patient look pale. The young person also may be tired, because the thin blood cannot carry enough
oxygen to the heart, lungs, and muscles.
• If blood platelets are crowded out in the bone marrow, the young person may have bleeding
problems and unusual bruising.
• If the normal, mature kind of white cells known as neutrophils are crowded out by the blasts, there
will be no cells to combat bacteria, and infections may occur.

In some cases, leukemic blasts may spill over from the bone marrow into the blood, where they can
be seen by microscopic examination. This may cause a rise in the number of white cells in the blood
(the white blood cell count). In other cases, only a few blasts appear in the blood, and the white cell
count does not change much. When leukemic blasts are present in the blood, they may be carried to
other places in the body and enter various body organs. Sometimes they grow in these organs as
well as in the bone marrow.
 Cancer cells Normal cells

ACUTE MYELOGENOUS LEUKEMIA

A PICTURE OF ACUTE MYELOGENOUS LEUKEMIA

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow — the spongy
tissue inside bones where blood cells are made.

It's called acute leukemia because it progresses rapidly and affects immature blood cells, rather than
mature ones. It's called myelogenous (MI-uh-loj-uh-nus) leukemia because it affects a group of white blood
cells called the myeloid cells, which normally develop into the various types of mature blood cells, such as
red blood cells, white blood cells and platelets. This type of leukemia is also known as acute myeloid
leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia.

Normally, your bone marrow produces immature cells (stem cells) in a controlled way, and they mature
and specialize into the various types of blood cells as needed. In people with acute myelogenous leukemia,
the bone marrow produces immature cells that usually develop into a type of abnormal white blood cell.
These abnormal cells aren't able to mature and perform their usual functions. Even worse, they multiply
rapidly and can crowd out healthy cells, leaving a person with acute myelogenous leukemia vulnerable to
infection, anemia or easy bleeding. Leukemia cells can also spread outside the blood to other parts of your
body.Acute myelogenous leukemia is the most common form of leukemia. It worsens quickly if not treated,
but it initially responds well to treatment. Unfortunately, many people with acute myelogenous leukemia
experience a relapse. Much research is focused on decreasing the risk of relapse and improving the long-
term outcomes for people with acute myelogenous leukemia

CAUSES

The cause of acute myelogenous leukemia is damage to the DNA of developing cells in your bone
marrow. Under normal circumstances, your DNA is like a set of instructions for your cells, telling them
how and when to grow and divide. Certain genes on your DNA called oncogenes promote cell division.
Other genes, called tumor suppressor genes, slow down cell division and cause cells to die at the
appropriate times.

Acute myelogenous leukemia can occur when damage to DNA turns on oncogenes or turns off tumor
suppressor genes. When this happens, blood cell production goes awry. The bone marrow produces
immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are
unable to function properly, and they can build up and crowd out healthy cells.The DNA mutations that
cause leukemia are usually acquired — rather than inherited — but researchers and doctors don't always
understand exactly how. In some cases, damage to DNA is the result of exposure to cancer-causing
chemicals, including previous chemotherapy for other cancers. There's also a chance of AML progressing
from other blood diseases and chronic leukemias, such as chronic myelogenous leukemia, myelodysplasia
or other disorders in which the bone marrow produces too much of certain types of blood cells
(myeloproliferative disorders).

RISK FACTORS

The risk of acute myelogenous leukemia increases with age. It's most prevalent in people in their 60s
and older. The disorder is also more common in males than in females. Other possible risk factors include:

• Cancer therapy. People who've had certain types of chemotherapy and radiation therapy or
treatment for childhood acute lymphocytic leukemia (ALL) may have a greater risk of developing
AML.
• Exposure to radiation and certain chemicals. People exposed to very high levels of radiation,
such as survivors of an atomic bomb blast or a nuclear reactor accident, have an increased risk of
developing AML. Exposure to certain chemicals, such as benzene — which is found in unleaded
gasoline and used by the chemical industry — also is linked to greater risk of AML.
• Smoking. AML is linked to cigarette smoke, which contains benzene and other known cancer-
causing chemicals. Smokers older than 60 face twice the risk of AML that nonsmokers do.
• Other blood disorders. People who've had another blood disorder, such as myelodysplasia,
polycythemia vera or thrombocythemia, are at greater risk of developing AML.
• Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an
increased risk of AML.

Nursing Interventions

1. Care Guide in Patient with disease Condition

TREATMENT

Treatment of patients with acute myelogenous leukemia depends on age and the subtype of the
disease. In general, treatment falls into two phases:

• Remission induction therapy. The purpose of the first phase of treatment is to kill the leukemia
cells in your blood and bone marrow. However, remission induction usually doesn't wipe out all of
the leukemia cells, so you need further treatment to prevent the disease from returning.
• Consolidation therapy. Also called post-remission therapy, maintenance therapy or intensification,
this phase of treatment is aimed at destroying the remaining leukemia cells. It's considered crucial to
decreasing the risk of relapse.

Therapies used in these phases include:

• Chemotherapy. Chemotherapy is the major form of remission induction therapy. A common

course of therapy involves two chemotherapy drugs — cytarabine (Cytosar-U), followed by an
anthracycline drug, such as daunorubicin (Cerubidine) or idarubicin (Idamycin). A third medication,
thioguanine, is sometimes used.

If you have AML, you'll probably stay in the hospital during the treatment cycle because the
chemotherapy destroys many normal blood cells in the process of killing leukemia cells. This
chemotherapy can cause anemia, infection and bleeding. If the first cycle of treatment doesn't cause
remission, you may need it repeated one or two more times. Other drug combinations also may be
used, depending on your specific situation.

Chemotherapy can also be used for consolidation therapy. This phase may include a combination of
different medications that mimic the induction, but usually includes high doses of cytarabine by
itself for one to three cycles. Your doctor may also prescribe medications that boost white cell
production to reduce the risk of infection. These medications are called granulocyte colony
stimulating factors (Neupogen, Leukine).
 • Other drug therapy. Arsenic trioxide and all-trans retinoic acid (ATRA) are anti-cancer drugs that
can be used alone — or in combination with chemotherapy — for remission induction of a certain
subtype of AML called promyelocytic leukemia. These drugs cause leukemia cells with a specific
gene mutation to mature and die, or to stop dividing.
• Biological therapy. Also known as immunotherapy, biological therapy uses substances that bolster
your immune system's response to cancer. Monoclonal antibodies are one form of biological
therapy. These antibodies are produced in a laboratory, but they mimic protein products found in
your immune system (antibodies) that attack foreign substances (antigens) on leukemic cells.
Gemtuzumab ozogamicin (Mylotarg) is a monoclonal antibody linked to a chemical toxin that
attaches to AML cells. It's used to treat older people with AML who don't respond to initial
treatment or who relapse after successful initial treatment. Researchers are testing its effectiveness
in younger people with AML.
• Bone marrow transplant. This is another option for consolidation therapy for people at high risk
of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to
re-establish healthy stem cells by replacing their leukemic bone marrow with leukemia-free
marrow. If you choose this treatment, you'll receive very high doses of chemotherapy or radiation
therapy to destroy your leukemia-producing bone marrow. This marrow is then replaced by bone
marrow from a compatible donor (allogeneic transplant). In some cases, you may also be able to use
your own bone marrow for transplant (autologous transplant). This is possible if you go into
remission and then save healthy bone marrow for a future transplant.
• Stem cell transplant. Stem cell transplant is also used for consolidation therapy. It's similar to bone
marrow transplant except the stem cells are collected from circulating blood (peripheral blood),
rather than from the bone marrow, thanks to a medication that causes larger numbers of stem cells
to be released from the bone marrow. The cells used for transplant can be your own healthy cells, or
they can be collected from a compatible donor. This procedure is used more frequently than bone
marrow transplant because of shortened recovery times and possible decreased risk of leukemia
recurrence.

1. Radiation Therapy.Radiation therapy involves the use of radiation to kill cancer cells and
shrink tumors. For AML, external radiation therapy is used.In external radiation therapy radiation
is directed at the tumor from a source outside the body. This type of treatment is used for AML that
has spread—or may spread—to the brain and spinal cord. It can also be used to treat bone pain that
comes from bone affected by the leukemia.

NCP
S- “ masakit lahat sakin lalo na lalamunan ko” as verbalized by the patient
O- weakness
-feeling of exhaustion
-low RBC counts: 1.93
- low hemoglobin count: 6.77
-shortness of breath
-fatigue
-blood pressure: 100/60 mmhg
A- Activity Intolerance: fatigue related to anemia
P- demonstrate a decrease in physiologic signs of intolerance

I- plan care with rest periods between activities

elevate head of bed as tolerated
provide positive atmosphere, while acknowledging difficulty of the situation of the patient
 provide quiet environment, maintain bed rest as indicated. Limit visitors, phone calls and reported
unplanned interruptions
prioritize nursing care schedules to enhance rest.
use energy techniques such as shower chair, sitting performing task
provide assistance with patient, including activities that the patient views as essential. Increase
activity levels as tolerated
instruct patient to stop activity if palpitations, chest pains, shortness of breath, weakness, dizziness
occur
change patient position slowly and monitor for dizziness
E- the patient shows a decrease signs of intolerance
VII. Evaluation and Recommendation:
Early detection of an ailment is vital to the patient. Oftentimes lack of in-depth knowledge
regarding a condition of a disease may hinder a patient in seeking immediate advice from medical
specialist. Fear and financial problems may sometimes interfere which may often lead to the severity of the
disease.
This I believe is one of the major causes as to why my patient has gone to this terminal stage of his
Acute Myelogenous Leukemia (AML). The nature of his job as a painter exposes him to great risk of an
organ damage. Petroleum products when exposed to a person to a considerable period of time may often
lead a person to this problem. This is also coupled with lack of knowledge regarding this health hazard.
According to his recent laboratory results, his platelet is 27,000 /cu mm which is very low
compared to the normal platelet count of 150,000-450,000/ cu mm. This shows a decrease in both platelets
and erythrocytes. The patient shows hematuria, melena and petechiae on his both upper and lower
extremities, this is an indication of decrease in platelet as well. Because of lack of mature and normal
granulocytes, the patient had a massive tonsillitis. Since treatment for chemotherapy is too costly for the
patient this could contribute for a compelling severity of his health condition.
It is necessary to undertake sessions of chemotherapy to prolong the patient’s life. Immaturity of
leukocytes can also lead to severe infection, the patient is encouraged to wear mask whenever the condition
necessitates. The patient needs proper rest due to fatigue. He also needs more encouragement from his
immediate family member, relatives and friends.
Government sector plays a great role in sustaining financial support for indigent patients. Health
care institutions can also help in the financial assistance of their members. Advancement of medical
technology and profession is always a mileage in the science of medical world.