communication needs if applicable splinting incision ICU Post-op promote ventilation chest tubes promote comfort I&O pneumonectomy no chest tubes position on back, operative side check for mediastinal shift Discharge arm exercises wound care, s/s infection follow-up radiation/chemotherapy Radiation and chemotherapy palliation for pain control
Leukemia Leukemia Types of Leukemia Treatments Nursing process Leukemia “White blood” Group of chronic malignant disorders of WBCs/ precursors replacement of bone marrow by malignant, immature, circulating WBCs infiltration of cells into liver, spleen, lymph nodes Incidence and Risk factors Adult: 10 times more frequent than children Genetic: Down syndrome Environmental: exposure to cigarette smoking, benzene chemicals in gasoline, ionizing radiation Pathophysiology Stem cell malignancy: accumulate in bone marrow Immature cells replace normal hematopoietic elements Results in severe anemia, splenomegaly, and bleeding difficulties infiltrate to CNS, testes, GI tract, lymph nodes, liver, spleen Classifications Acute: acute onset, rapid disease progression, immature blast cells Chronic: gradual onset, prolonged course, abnormal mature cells Lymphocytic: immature lymphocytes/ precursor bone marrow cells Myeloid: myeloid stem cells, decreased maturation of granulocytes RBCs and thrombocytes Type of Leukemia Acute lymphocytic (ALL) Chronic lymphocytic (CLL) Acute myeloid (AML) Chronic myeloid (CML) Acute lymphocytic (ALL) Myeloblast (precursors of granulocytes) proliferation and bone marrow/spleen hyperplasia Common in older adults Neutropenia (severe infection) and thrombocytopenia (bruising, hematuria, GI bleeding) Chemotherapy, SCT Chronic Myeloid Leukemia Abnormal proliferation of all bone marrow elements Onset 30, 40, or 50 years Chromosome abnormality (Philadelphia chromosome), translocation of chromosome 22 to 9 Terminal blast crisis-later progression to acute leukemia with blast cell proliferation and skin, lymph node, bone, CNS infiltration Interferon alpha: chemotherapy, SCT Acute Lymphocytic Leukemia Malignant immature B cells (lymphoblasts) proliferate in bone marrow Thromobocytopenia, leukopenia and anemia Chemotherapy: complete remission in 80% of adults Chemotherapy; BMT, or SCT Chronic Lymphocytic Leukemia Abnormal, mature, B lymphocyte proliferation in bone marrow, peripheral blood, body tissues Older adults (65 and older) Often requires no treatment; chemotherapy, BMT Diagnosis CBCD : evaluates cell counts, H&H number, distribution, size and shape of WBCs Plt: identify thrombocytopenia and bleeding risk Bone marrow examination: identify cell marrow information, type of erythropoiesis, maturity of erythropoietin and leukopoietic cells Chemotherapy Single agent or combination Induction phase : high doses to eradicate leukemic, cells Colony stimulating factors:
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- Fall '16
- Karen Price