ATI Ch.40 Blood Neoplasms
Types of Leukemia
- Acute Lymphoblastic Leukemia (ALL) - Acute Myelocytic Leukemia (AML) - Chronic Myelocytic Leukemia (CML)
How is leukemia diagnosed?
-Bone marrow aspiration or biopsy -CSF analysis -liver and kidney fucntion
What are the risk factors to blood neoplasms
-Male -Caucasian -Peak onset 2-5years -Family hx of leukemia -Trisomy 21 downsyndrome Leukemia is most common cancer in children
A nurse is caring for a child who is experiencing neuropathy due to chemotherapy. Which of the following are manifestations of neuropathy? (Select all that apply.) A. Constipation B. Skin breakdown C. Foot drop D. Jaw pain E. Hemorrhage cystitis
A. CORRECT: Constipation is a manifestation of neuropathy. C. CORRECT: Foot drop is a manifestation of neuropathy. D. CORRECT: Jaw pain is a manifestation of neuropathy.
A nurse is caring for a child who has thrombocytopenia. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor for signs of bleeding. B. Administer routine immunizations. C. Obtain rectal temperatures. D. Avoid peripheral venipunctures. E. Limit visitors.
A. CORRECT: The child who has thrombocytopenia is at risk for hemorrhage. Monitoring for findings of bleeding is an appropriate action for the nurse to take. D. CORRECT: The child who has thrombocytopenia is at risk for bleeding. Avoiding venipunctures is an appropriate action for the nurse to take.
A nurse is assessing a child who has leukemia. Which of the following are early manifestations of leukemia? (Select all that apply.) A. Hematuria B. Anorexia C. Petechiae D. Ulcerations in the mouth E. Unsteady gait
B. CORRECT: Anorexia is an early manifestation of leukemia. C. CORRECT: Petechiae is an early manifestation of leukemia. E. CORRECT: Unsteady gait is an early manifestation of leukemia.
A nurse is caring for a child who has oral mucositis. Which of the following actions should the nurse take? (Select all that apply.) A. Swab the mucosa with lemon glycerin swabs. B. Apply viscous lidocaine. C. Offer soft foods. D. Use a soft, disposable toothbrush for oral care. E. Encourage gargling with a warm saline mouthwash.
C. CORRECT: Offering soft foods decreases the amount of chewing needed and possible irritation. D. CORRECT: A soft toothbrush allows for adequate cleaning of the mouth and decreases irritation. E. CORRECT: A warm saline mouthwash is effective in soothing mucositis.
A nurse is planning care for an infant who is scheduled to have a lumbar puncture. Which of the following actions should the nurse include in the plan of care? A. Cleanse the thoracic area of the infant's back with an antiseptic solution. B. Apply a eutectic mixture of local anesthetic cream just before the procedure begins. C. Restrain the infant during the procedure to prevent movement. D. Position the infant with his head extended and chin raised.
C. CORRECT: Restraining the infant during the procedure to prevent movement will decrease the potential for injury. It is an appropriate action for the nurse to take.
What is the treatment for leukemia?
Chemotherapy in 4 phases Hematopoietic stem cell transplant Radiation therapy to the brain
What are some nursing considerations for during a LP?
Empty bladder Topical anesthetic cream 1 hr prior Side-lying flexed position Can sedate with fentanyl or midazolam Pressure dressing postop and assess for bleeding Remain in flat position for 4-8 hrs
What are complications of myelosuppression?
Hemorrhage: thrombocytopenia Anemia: might need blood transfusion and IV fluid replacement
Leukemic blasts
Immature WBCs
What are the side effects to chemotherapy?
Mucosal ulcers: oral care, chlorhexidine or salt baking soda mouth wash, lubricate lips local anesthetics Skin breakdown: assess for fissures and give sitz bath, reposition Neuropathy: interventions for constipation, foot drop, jaw pain with soft diet Loss of appetite: daily weights, small freq meals, enteral nutrition, do chemo in the morning Hemorrhage cystitis: encourage fluids and voiding Alopecia: hat, scarf, wig
What is the complication with leukemia therapy?
Myelosuppression so... -provide private room to reduce airborne pathogens -Strict infection control -Adequate protein and caloric intake -No live vaccines -monitor absolute neutrophil count LATE effects: cognitive and neuropsychological defects
What are some nursing considerations for during a bone marrow aspiration or biopsy?
Use local anesthetic cream 1 hr prior to procedure Can use unconscious sedation w/propofol Position pt for access site in iliac crest or tibia for infants Postop apply pressure for 5-10min w/pressure dressing and assess for bleeding
Bone marrow infiltration
causes crowding of cells that would normally produce RBCs, platelets, and mature WBCs
Anemia
deficient RBCs, low blood count
Neutropenia
deficient mature WBCs, low neutrophils
Thrombocytopenia
deficient platelets causing bleeding, low platelets
Nursing considerations with Hematopoietic stem cell transplant (allogeneic transplant)
donor cells administered via IV -positive pressure room -HEPA air filtration
Leukemia
group of malignancies that affect the bone marrow and lymphatic system. WBC that becomes neoplastic causing an increase in the production of immature WBCs which leads to infiltration of organs and tissues
Infiltration of the CNS causes
increased ICP
Tissue fibrosis is caused by
infiltration of the spleen, liver and lymph nodes
What are early manifestations of blood neoplasms?
low-grade fever pallor bruising and petechia enlarged liver, lymph nodes and joints abdominal, leg and joint pain unsteady gait
What are late manifestations of blood neoplasms?
pain hematuria ulcerations in the mouth enlarged kidneys manifestations of ICP
