Leukemia

Maintenance therapy Goal-

prevent relapse

Total treatment time for ALL is

2 1/2 yrs for girls and 3 1/2 yrs for boys

Report moderate to severe neutropenia

500-1000= moderate neutropenia < 500= Severe neutropenia

The presence of more than _____in the marrow at day 28 is an ominous sign of a poorer prognosis

5% blasts

A bone marrow aspirate usually provides sufficient material to establish the diagnosis of

Acute Lymphocytic leukemia

Why is acetaminophen preferred for fever

Aspirin and Ibuprofen given to a child who is thrombocytopenic can cause platelet dysfunction

Nursing care- Assess for

Assess for other indicators of infection- crackles, cough, urinary frequency, or urgency, oliguria, lesions of skin or mucous membranes

Subjective and Objective Data Acute Leukemia

Bone pain, joint swelling Hepatosplenomegaly Weight loss, Fever Poor wound healing anemia. fatigue, pallor, tachycardia, dyspnea, on exerction Evidence of bleeding= eccymoses, hematuria, bleeding gums, epistaxis

.Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? a. 24 hours b. 2 to 4 days c. 7 to 14 days d. 21 to 28 days

C. Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

_______ Most cases involve young adults. Uncommon in children; prognosis is less than 2 years of survival from the time of diagnosis

CML- Chronic Mylogenous leukemia

Most common sites that cells infiltrate

CNS & Testicles (common sites of a relapse)

__________ is the phase of therapy for ALL that follows induction and remission.

Consolidation

Phase 2 Consolidation or intensification therapy for ALL

Cure by eradication any residual leukemic cells

Six weeks after hematopoietic stem cell transplantation for leukemia, the client's white blood cell (WBC) count is 8200/mm3. What is the nurse's best action in view of this laboratory result?

Document the laboratory report as the only action. The WBC count is now within the normal range (5000 to 10,000/mm3) and is an indicator of successful engraftment. The client is not at any particular risk for infection at this time, nor is there reason to believe an infection is present. (At any post-transplantation check-up, the client is assessed for infection.)

Bone Marrow transplant complications

Failure of stem cells to engraft Graft-versus-host disease ( graft rejection) Nursing action- admin immunosuppressants as prescribed

The analysis of the bone marrow cells using a laser beam, another test performed on the initial bone marrow, is called

Flow cytometry (provides a rapid diagnosis by characterizing the type of leukemia within hours)

A priority Nursing intervention is

Frequent, thorough hand hygiene

A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? . Infection Hemorrhage Pain Anemia

Hemorrhage

Most cases involve young adults Possible causes include viral infections and exposure to chemical agents

Hodgkin's lymphoma

Phase 1 of Chemotherapy Induction therapy-intensive combination therapy GOAL

Induce remission- absence of all findings of leukemia, including less than 5% blasts in bone marrow

___________is given prophylactically to prevent relapse in the CNS. If the testes are involved__________is given

Intrathecal chemotherapy Radiation

Sites that could show enlargement

Lymph nodes, Liver, Spleen, Joints

_____are cancers that of lymphocytes (a type of WBC) and lymph nodes (which produce antibodies and fight infection)

Lymphomas

Anemia increases the risk for hypoxemia Nursing Actions

Monitor RBC, provide a diet high in protein and carbohydrates Administer colony-stimulating factors, such as epoetin alfa (procrit) as prescribed Admin blood products (packed red blood cells) as needed

Acute mylogenous leukemia affects what age group

Most common leukemia among Adults; prognosis is poor

The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period?

Nadir The lowest point of bone marrow function is referred to as the nadir.

For the hospitalized neutropenic child, what extra precautions are taken to prevent infection

No fresh flowers, fruit (fungal spores) Do not use humidifiers No live viral or bacterial vaccines Use sterile tech to change bandages

Prevent transmission of bacteria and viruses

No live plants, flowers Use HEPA filtration- NO humidifiers Eliminate standing water- denture cups, vases Encourage GOOD personal hygiene AVOID CROWDS

More common in clients older than 50 Possible causes include gene damage, viral infections, autoimmune disease, and exposure to radiation or toxic chemicals

Non-Hodgkin's

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea?

Ondansteron (Zofran)

For Imbalanced nutrition < body requirements

Outcome- Experience no more than 5% weight loss (weigh daily) Cool liquids and food are soothing and tolerated better Small frequent meals of high protein

Complication from Bone Marrow Transplant- A decrease in white and red blood cells and platelets

Pancytopenia

___________may be given in situations when lysing of the tumor by chemotherapy is expected to be significant.

Parenteral urate oxidase-(this recombinant enzyme oxidizes uric acid into water soluble product that can be excreted)

Reinduction therapy-for the client who relapses Goal-

Place the client back in remission

Hodgkin's lymphoma what cell is present in the biopsy

Reed Stern-berg cell ( B lymphocytes)

What test is used for the detection of CML, and what age group is mostly affected ?

The Philadelphia Chromosome test Young adults

Allogenic cells are obtained from

an HLA matched donor, such as a relative or from umbilical cord blood (closely matches Human leukocyte antigens)

A decreased platelet count increases the risk for

bleeding and intracrainial hemorrhage- one of the most common sites for bleeding is the NOSE

Screening and diagnostics

coagulation time is increased- monitor for bleeding Biopsy of bone marrow- large amount of immature leukemic blast cells Typing of protein markers to differentiate myeloid or lymphoid CBC- ↓H&H, ↓ Plt, ↓RBCs, ↑WBC CT scan (always used for HL staging) Biopsy of Lymph nodes- Hodgkin's- presence of Reed-Sternberg cells (B-lymphocytes) Any other lymph mode malignancy-Non-Hodgkin's

If platelet count is low, the use of a_______________is used instead of a toothbrush

cotton tipped applicator, finger cot, or washcloth around a finger

The greatest risk is at platelet counts Spontaneous bleeding can occur at platelet count Nursing actions

counts less than 50,000/mm at less than 20,000/mm Minimize trauma -safe environment Administer blood products (platelets) as needed

Possible symptoms include

decreased activity level, persistent or recurrent fever more bruises than usual, intermittent stomachaches, leg pains with refusal to walk

Synergenic cells

donated from the client's identical twin (HLA identical)

HL & NHL subjective and objective data

enlarged lymph node possible fever, fatigue, and infections

The Nurse should check for

fever, fatigue, pallor, bruising on extremities, petechiae in the mouth and sclera, hepatomegaly, very high WBC count, and bleeding

Colony-stimulating medication such as _________ stimulate the production of leukocytes. Monitor for

filgrastim (Neupogen) Monitor for report of bone pain. CBC twice weekly Use caution with clients who have bone marrow cancer

At the first sign of mouth ulcers, begin a mouth care regimen of

four times a day, which includes use of antifungal drug as ordered by physician. **Do Not use alcohol-containing mouthwash

Restrict foods that may be contaminated with bacteria these include

fresh or raw fruits and vegetables (No fresh flowers either)

Prevent infection Implement neutropenic precautions by

hand hygiene Private room Screen visitors carefully-Allow only well visitors ( or ill must wear a mask) Monitor WBC

A lumbar puncture is also performed to look for

leukemic blast cells in the spinal fluid, which are indicative of CNS involvement

Check for mental and neurologic function due to risk of

leukemic infiltration onto the CNS

Maintenance chemotherapy usually consists of

lower doses of chemo given orally or IV on a regular basis over a period of 2 to 3 years to maintain remission

The goal of consolidation therapy is to _____________________________

maintain remission and prevent disease in extramedullary "sanctuary sites" such as the testes and CNS

The confirmatory test for Leukemia is

microscopic examination of the bone marrow- obtained by aspiration or biopsy.

Phlebitis may occur up to 1 month after bone marrow transplant-Nursing actions

monitor for jaundice, abdominal pain, and liver enlargement monitor daily weights and abdominal girth to assess for fluid retention

Food for oral mucosa irritation

offer bland, non-irritaing foods and cool liquids

If anal/rectal mucosa become become irritated what intervention is needed

several sitz baths several times a day, and after bowel movements In diaper wearing children- use non alcohol wipes or warm water only

Autologous cells

the client's own cells that are collected before chemotherapy

The peak of bone marrow function occurs

when the client's blood levels are at their highest.