LEUKEMIA

Kimberly Ambruso, RN, MS NU 102 Fall 2012

What is cancer?
Malignancy: cells that grow and proliferate in a disorderly or chaotic fashion
The cells have lost their ability to perform their intended function

Presumed Causes
Adults vs. Kids
Embryonic Rapid growth

Impaired immune function

Viral infections
HIV Epstein Barr

Environmental
Radiation exposure (Carcinogens) Other sources?

Medications
Chemotherapy Immunosuppressants

Genetic
Inherited: retinoblastoma Chromosomal:
Down syndrome

Incidence of Pediatric Cancers

Leukemia: most common in most age groups Brain & CNS Lymphomas: increases with age Bone/sarcoma: increases with age (teens)

General Symptoms
Bleeding and bruising History of respiratory infections Weakness, fatigue Pain, tenderness, joint swelling, decreased ROM, unsteady gait Abdomen: swelling, pain, change in bowel pattern Mass: may be palpable Neurological changes Enlarged lymph nodes Unexplained weight loss/ cachexia

Leukemia
A group of disorders characterized by the uncontrolled proliferation of abnormal immature blood cells Lymphoid or myeloid
Blast cells

Most common form of childhood cancer More common in boys

TYPES ALL- Acute Lymphoblastic Leukemia AML- Acute Myelogenous Leukemia Chronic Leukemias- much less common in children
CML CLL

Leukemia
Symptoms
Fever Bleeding/bruising/ petechiae Fatigue Pallor Bone pain Recent infection Hepato/spenomeg-aly

Treatment
Chemotherapy CNS treatment
Chemo radiation

Testicular radiation Bone Marrow Transplant

Leukemia Diagnostics
CBC with differential
WBC
Lymphocytes Neutrophils (Absolute Neutrophil Count)

Biopsies
Lymph nodes Testicles

Platelets
Normal range?

Hgb/Hct
Normal Hgb? Normal Hct?

Leukemia Diagnostics
Bone Marrow Aspiration Under anesthesia/conscious sedation
Propofol (Diprivan) very short acting

Lumbar Puncture Detects presence of cancer cells in CSF

Pelvic bone- anterior or superior iliac crest 10-14 g. needle

Cancer Chemotherapy
Attempts to kill rapid growing/abnormal cells Kills normal (good) cells in the process Cell-cycle specific Combinations are almost always used Protocols
roadmaps Based on research/evidence May be institution specific or national protocols

Chemotherapy for Leukemia

ALL
2-3 yrs Bone marrow Transplant (BMT) if relapse
Pre-chemo
Hydration Baseline Cardiac Function Labs
CBC Chemistry Renal function

AML
Intense therapy, 6 months BMT (if remission is achieved)

Nursing Care-Chemotherapy
Common side effects
Nausea, vomiting, diarrhea Alopecia Neutropenia,. Thrombocytopenia, anemia Mucositis Renal, hepatic insufficiency

CVAD care Types of access devices Routine nursing care complications

Neutropenic precautions
Private room No thin skinned fruits or Dedicated stethoscope, vegetables BP cuff, thermometer No raw foods, fast foods Meticulous hygiene No flowers Heavy duty cleaning at No pets, goldfish home Screening of visitors

Mucositis
Nystatin Peridex (chlorhexidine gluconate) or Biotene Miracle Mouithwash PO fluid choices NO OTC mouthwash

Long Term effects

CNS
Below average academic achievement/IQ Visual spacial skills Memory/attention Motor skills

Cardiac
Left ventricular dysfunction

Hearing Musculoskeletal
Avascular necrosis osteoporosis

Growth Hormone Failure Sterility/reduction in sperm/ovary production

Dental Secondary cancers Psychosocial

Bone Marrow Transplant

Replacement of diseased marrow with healthy marrow Leukemias, lymphomas Allogeneic Solid tumors, lymphomas Autologous High doses of chemo and/or radiation Transplant: resembles a blood transfusion Side effects: same as with chemotherapy, but much more magnified

Bone Marrow Transplant Side Effects

Related to transplant

Graft vs. host disease

Attack on the new body

Related to immunosuppressant therapy

Graft failure
Own cells take over

Mood swings Hyperglycemia Weight gain Seizures Hirsutism Body image