Avoid high altitudes, increase fluid intake, treat infections (avoid crowds), help with pain control, vaccinations o O2 for hypoxia and to control sickling o Pain management—morphine or hydromorphone continuous!!! (not PRN) o Chronic leg ulcers may be treated with bed rest, abx, warm saline soaks, mechanical or enzyme debridement, grafting o Fluids and electrolytes administered to reduce blood viscosity and maintain renal function o During acute crisis, optimal pain control usually includes large doses of continuous opiod analgesics along with breakthrough analgesia o Hydroxureia-antisickling agent Increased production of hgb F (fetal) decreases reactive neutrophil count, increases erythrocyts volume and hydration, and alters adhesion of sickle eruthrocytes to endothelium Eruthropoietin in patients unresponsive to hydroxyurea o Hematopoietic stem cell transplant can cure some patients Slide 59 Chapter 34 Leukemia
Group of malignant disorders affecting blood and blood forming tissues of bone marrow, lymph system, spleen Accumulation of dysfunctional cells to loss of regulation in cell division Occurs in all age groups Usually starts in WBCs—bone marrow produces abnormal WBCs, which don’t function properly o Certain abnormalities cause cell to grow and divide more rapidly and continue living when normal cells would die o Over time these abnormal cells can crowd out healthy blood cells in bone marrow, leading to fewer healthy cells and causing s/s of leukemia Pathophys o No single causative agent o Combination of genetic/environmental influences (chemical, radiation, viruses, downs syndrome, smoking, family history) o Chromosomal changes have led to discoveries of how normal genes, once transformed, can result in abnormal genes capable of causing many types of cancers Acute vs chronic o Cell maturity and nature of disease onset Classified by how fast leukemia progresses o Acute-clonal proliferation of immature hematopoietic cells Abnormal blood cells are immature that can’t carry out normal work-multiply more rapidly, disease worsens faster—requires aggressive treatment ALL Most common type in children Immature lumphocytes proliferate in bone marrow (b-cell origin) s/s appear abruptly—fever/bleeding insidious with progressive weakness, fatigue, pain, bleeding CNS manifestations Arachnoid infiltration can cause leukemic meningitis (occurs often) AML (acute nonlymphoblastic) Abrupt, dramatic onset—serious infection or abnormal bleeding Uncontrolled proliferation of myeloblasts—hyperplasia of bone marrow and spleen Clinical manifestations r/t replacement of normal hematopoeietic cells in marrow by leukemic myeloblasts o Chronic-mature forms of WBC, more gradual onset More mature blood cells replicate or accumulate more slowly and can function normally for period of time—can go unnoticed for years CLL Affects lymphoid cells which form lymphoid or lymphatic tissues Most common in adults Production and accumulation of functionally inactive but long lived mature appearing lymphocytes (b-cell involvement)
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