Question

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.

2. Formulate a Nursing Care Plan for a patient with Acute Leukemia.

3. Enumerate the nursing implications for the administration of blood components.

Answer 1

Leukemia is a disease that is classified by the type of white blood cells that are affected and by the quick progress action of the disease. Lymphocytic leukemia develops in the white blood cells. Myeloid leukemia may also start in white blood cells as well as red blood cells and platelets.

The 4 types of leukemia include the following:

Acute lymphocytic leukemia (ALL), Chronic Lymphocytic leukemia (CLL), Acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). In terms of how quickly it develops, leukemia is classified as either acute ( fast-growing) or chronic (slow-growing).

Incidence:

ALL: It is the most common type of childhood cancer. Most cases occur between ages 2 and 5.

CLL: It is the most common type of leukemia in adults older than 19, accounting for 37% of cases.

AML: It is the second most common type of leukemia diagnosed in adults and children, but most cases occur in adults. AML makes up 32% of all adult leukemia cases.

CML: The average age at diagnosis of CML is around 64 years. Almost half of the cases are diagnosed in people 65 and older.

Physiologic alteration:

ALL: It is caused by a series of acquired genetic aberrations. Malignant transformation usually occurs at the pluripotent stem cell level, although it sometimes involves a committed stem cell with a more limited capacity for self-renewal.

CLL: It is characterized by the clonal expansion of cells in the blood, marrow, and second lymphoid tissues.

AML: It develops as the consequence of a series of genetic changes in a hematopoietic precursor cell.

CML: It involves the accumulation of myeloid precursor cells in the bone marrow and blood.

Clinic manifestations:

ALL: Tired, weak, dizzy feeling, shortness of breath, pale skin, bruises on the skin, bleeding gums, nosebleeds, or heavy menstrual bleeding in women.

CLL: Swelling of lymph nodes or glands in the neck, underarms, and groin, discomfort in the upper left part of the abdomen, fever, chills, night sweats and weight loss, abdomen bleeding.

AML: The onset of symptoms is usually quite abrupt and may include severe infection and abnormal bleeding. Tiredness, feeling cold and dizzy, headaches, pale skin, shortness of breath.

CML: Fatigue, such as shortness of breath, fever, excessive sweating, weight loss, abdominal swelling, itching, bone pain.

Management:

ALL: Confirmation of diagnosis, risk stratification, combination Chemotherapy+/- radiotherapy, supportive therapy, treatment of complications, and follow-up for 5-6 event-free years.

CLL: Drug combinations can be used as the first treatment, radiation or surgery, leukapheresis, stem cell transplant.

AML: The main treatment is chemotherapy, along with drug therapy.

CML: The standard treatment is tyrosine kinase inhibitor like imatinib, nilotinib, dasatinib or bosutinib.

Prognosis:

ALL: About 98% of children with ALL go into remission within weeks after starting treatment. About 90% of those children can be cured. Patients is considered cured after 10 years in remission.

CLL: The survival rate for people age 20 and older with CLL is 85%.

AML: Prognosis varies depending on the subtype, but <15 have increased to 58% and for those 15 to 19 to40%. Above 60 to 70% of adults achieve remission after induction therapy with about 25% surviving for 3 years or more. Remission tends to be shorter in duration in adults >60.

CML: Patient treated with imatinib are found that about 90% of them stays alive 5 years after starting treatment.

Nursing Care Plan for a patient with Acute Leukemia:

1. Risk for Infection.

2. Risk for Deficient Fluid Volume.

3. Acute Pain.

4. Activity Intolerance.

5. Deficient Knowledge.

Nursing implications for the administration of blood components:

1. If the blood transfusion reaction occurs, we should stop the transfusion.

2. Place the client in Foeler’s position if with Shortness of Breath and administer O2 therapy.

3. Start IV line.

4. The nurse remains with the client, observing signs and symptoms.

5. Notify the physician immediately.

6. The nurse prepare to administer emergency drugs as per the physician’s order.

7. Obtain a urine specimen and send to the laboratory to determine the presence of haemoglobin.

8. Blood container, tubing, and transfusion record are saved and returned back to the laboratory for analysis.