Question

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.

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

• Enumerate the nursing implications for the administration of blood components

Answer 1

	Acute lymphocytic leukemia (ALL)	Chronic lymphocytic leukemia (CLL)	Acute myeloid leukemia (AML)	Chronic myeloid leukemia (CML)
incidence	This year there are estimated to be 60,300 people diagnosed with leukemia. About 382,000 people live, or are in remission, with leukemia. 170 Americans get diagnosed with leukemia each day and 67 lose the fight.	CLL is the most common form of leukemia in adults over 19 years of age, comprising 37 per cent of cases. An estimated 21,040 people of all ages (12,930 men and 8,110 women) are diagnosed with CLL in the United States this year. In older adults CLL is more popular.	About 19,940 new cases of acute myeloid leukemia. The bulk would be in adults. Around 11,180 AML fatalities	About 15 per cent of all leukemia is CML. An estimated 8,450 people (4,970 men and 3,480 women) are diagnosed with CML in the United States this year
physiologic alterations	Acute lymphocytic leukemia develops when a cell in the bone marrow is producing DNA errors. The mistakes tell the cell to continue to expand and divide when a healthy cell usually stops dividing and ultimately dies. As that happens, development of blood cells becomes anomalous.	The clonal expansion of CD5+CD23 + B cells in the blood, marrow, and second lymphoid tissues is characterized by chronic lymphocytic leukemia ( CLL). Profiling the gene expression and phenotypic studies show that CLL is possibly derived from CD5 + B cells close to those present in healthy adult blood.	The myeloblasts form the malignant cells in AML. The myeloblast is an immature source to white blood cells in myeloids. This myeloblast ripens into a mature white cell of blood. In AML, a single myeloblast can undergo a genetic change that fixes the cell at its immature state and prevents maturation and differentiation	CML is a disorder of the stem cells involving the aggregation of myeloid precursor cells in the bone marrow and blood. These cells have a distinctive abnormality in the gene where chromosome 9 and chromosome 22 are translocated
clinical manifestations	• Felt tired. • Feeling sick. • Felt light-headed or dizzy. • Breathlessness. • Light peel. • Diseases which do not go away or fail to come back. • Bruises on the skin (or tiny red or purple spots); • Bleeding, such as regular or serious female nosebleeds, bleeding gums or extreme menstrual bleeding.	• Weakness • Feeling tired. • Weight loss. • Chills. • Fever. • Night sweats. • Swollen lymph nodes (often felt as lumps under the skin) • Pain or a sense of "fullness" in the belly	• Fatigue (fatigue); • Defects. • Felt cold. • Felt light-headed or dizzy. • Heads. • Light peel. • Breathlessness.	• Defects. • Tired. • Sweat by night. • Lost weight. • Bone pain (caused by leukemia cells that migrate from the marrow cavity to the bone surface or into the joint) • Expanded spleen (feeling as a mass below the left side of the ribcage) • Pain in the abdomen, or a feeling of "fullness."
management	1. 1. Chemotherapeutics. Chemotherapy, which uses medications to kill cancer cells, is usually used by children and adults with acute lymphocytic leukemia as an induction therapy. ... 2. 2. Targeted therapy. ... 3. 3. Radiation treatment. ... 4. 4. Transplant bone marrow.	Some of the most widely used therapies include: Ibrutinib (Imbruvica), alone or with Acalabrutinib (Calquence) rituximab (Rituxan), alone or obinutuzumab (Gazyva), Venetoclax (Venclexta) and obinutuzumab.	The most common regimens for AML induction of remission include a drug called cytarabine, most frequently continuously administered via an intravenous ( IV ) line for seven days. An anthracycline, such as daunorubicin or idarubicin, is often administered in a single IV dose for the first week of each of three days of treatment	A tyrosine kinase inhibitor (TKI) such as imatinib (Gleevec), nilotinib (Tasigna), dasatinib (Sprycel), or bosutinib (Bosulif) is standard treatment for chronic phase CML. If the first drug stops working or it never worked very well at all, then the dosage may be increased or another TKI may be tried.
prognosis	Approximately 98 per cent of children with ALL go into remission within weeks after care begins. It is possible to cure around 90 per cent of those children. After 10 years of remission patients are deemed cured	CLL has a higher survival rate compared with many other cancers. The survival rate for five years is about 83 per cent. This means that, five years after diagnosis, 83 per cent of people with the disease are alive.	According to the National Cancer Institute ( NCI), the overall survival rate for AML for five years is 27.4 per cent. That means of the tens of thousands of Americans who live.	Analysis of patients taking the drug imatinib consistently showed that 90 percent lived for at least five years. It is important to note that estimates about survival rates are an estimation for people with CML.

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

Nursing diagnosis: Risk for Infection

Risk factors may include

• Insufficient secondary defenses: alterations in mature WBCs (low granulocyte and irregular lymphocyte counts), increased immature lymphocyte counts; immunosuppression, suppression of the bone marrow (therapy / transplant effects)

• Inadequate primary defenses (stasis of body fluids, traumatic tissue);

• Invasive procedures

• Chronic malnutrition;

Desired outcomes / criteria for the evaluation — patient will:

• To verbalize awareness of individual risk / causative factors.

• Recognize infection risk prevention / reduction interventions;

• Illustrate strategies, improvements in lifestyle, to encourage a healthy climate.

• Attain timely healing of wounds; be free from purulent drainage or erythema; be afebrile.

Nursing diagnosis: Risk for deficient fluid volume

Risk factors may include

• Excessive losses, e.g., vomiting, bleeding, diarrhea;

• Decreased consumption of water, for example nausea, anorexia

• Fluid loss through irregular routes, e.g. drains

• Increased need for blood, e.g. hypermetabolic, fever; predisposition to lysis syndrome in the kidney stone / tumor;

• Inadequate information on the cause and prevention of fluid deficiencies

• Médicaments : Diuretics

Desired outcomes/evaluation criteria—patient will:

• Indicate sufficient volume of fluid as shown by stable vital signs; visible pulses; urine production, precise gravity and pH within acceptable limits.

• Define the risk factors and corrective steps.

• Undertake lifestyle / behavioural changes to avoid dehydration.

Nursing diagnosis: Acute pain

• Physical agents, such as swollen organs / lymph nodes, bone marrow containing leukemia cells

• Chemical agents, for example antileukemic therapies

• Psychological causes, for instance anxiety and fear

Objective

· Used as proof of pain

· Retaining behaviour; guarding gestures; positioning to stop pain

· Face mask; sleep disturbance (eyes lack luster, motion fixed or dispersed, grimace)

• Emotional acts (such as restlessness, crying, alertness, irritability, sighing)
• Task diversion (e.g. pacing, finding other people and/or activities, repetition)
• Shift in tone of the muscle (may vary from flaccid to rigid)
• Diaphoresis; changes in blood pressure / heart rate / respiratory rate; dilation of the pupils

Nursing diagnosis: Activity intolerance

May be related to

• Generalized weakness; reduced energy reserves, increased metabolic rate resulting from massive leukocyte output

• Exhausted lifestyle

• Restless / Immobile

• Oxygen supply and demand imbalance (anemia / hypoxia);

• Care drawbacks (isolation / bedrest); drug therapy impact

Possibly evidenced by

• Subjectivity

• Verbal sleep / exhaustion study
• Exertional malaise / dyspnea

• Goal

• Irregular reaction to heart rate / blood pressure
• Electrocardiographic alterations that indicate arrhythmias / ischemia [Pallor, cyanosis]

Nursing Diagnosis: Knowledge Deficit regarding disease, prognosis, treatment, self-care, and discharge needs

May be related to:

• Lost resource disclosure

• Misinterpretation of details / lack of recall

• Data misinterpretation [data viewed inaccurately / incompletely]

• Ignorance of the information available

• Emotional control

• Lack of interest in learning [Client No Knowledge Request]

Possibly evidenced by:

· Subjective

Challenge verbalization

· Objective

· Incorrect follow-up of research instructions / performances

· Inappropriate / exaggerated actions (for example irrational, aggressive, angry, apathic)

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

The treatment of the patient undergoing a blood transfusion is paramount. Nurses are not only responsible for the actual administration of the blood product and the patient's care during their administration but also for detecting and handling any possible transfusion reactions effectively.

Nursing Interventions

• Confirm your doctor's order. ...

• Test the match and type in cross. ...

• Receive and register vital signs from baseline.

• Practicing strict asepsis.

• 2 or more registered nurses review the blood transfusion mark. ...

• Warm blood at room temperature to avoid chills before transfusion.

• Recognize consumer correctly.