1. Leukemia & Lymphoma Keith Rischer, RN, MA, CEN

2. Leukemia Patho Loss of regulation in cell division, causes proliferation of malignant leukocytes Classification based on predominant cell of origin Lymphoid Myeloid Acute or Chronic Lymphocytic leukemia Acute lymphocytic leukemia (ALL)most common w/peds Acute lymphocytic leukemia 5 yr survival 80% peds/40% w/adults Chronic lymphocytic leukemiaChronic lymphocytic leukemia (CLL)-most common w/adults 73% survival rate Myelogenous leukemia Acute myelogenous leukemia (AML) 20% survival rate Acute myelogenous leukemia Chronic myelogenous leukemiaChronic myelogenous leukemia (CML)

3. Leukemia: Etiology Chromosomal changes Chemical Agents-Benzene Chemotherapy-Alkylating Agents Viruses-Retroviruses Radiation Unknown factors

4. Leukemia Sx- Clinical Manifestations –Anemia –Fatigue and weakness –Bleeding –Fever and Infections –Weight loss-joint pain –Mouth sores –Hepatosplenomegaly & Lymphadenopathy Diagnosis

5. General Treatment of Leukemia Chemotherapy Induction therapy- attempts to induce or bring about remission. Consolidation therapy - after remission achieved-eliminate remaining cells Maintenance therapy- treatment with lower doses of same drugs every 3-4 weeks Combination therapy Stem cell transplant Bone marrow transplant

6. Nursing Management Acute Many emotional-psychosocial needs/support –Communicate tx plan-expected course –Protective Isolation/Neutropenic Precautions –Educate!! –Chemo-manage side effects –Spiritual care

7. Neutropenia Severe decrease in neutrophils-secondary to chemo or immunosuppressive therapy Sx: decreased immune/inflammatory response- masks infection…low grade fever significant >100.4 Nursing Management: –Neutropenic precautions –obtain pan cultures – start IV abx – assess for septic shock

8. Lymph System Consists of: lymphatic capillaries, ducts, lymph nodes, lymph fluid Function: –Returns excess interstitial fluid to the blood –Absorbs fatty acids –Produces immune cells –Lymph nodes: Filtration of bacteria and foreign particles carried by lymph fluid.

10. Lymphoma – Hodgkin’s Patho Incidence Clinical Manifestations –Enlargement of cervical, axillary or inguinal lymph nodes –* Wt Loss, *Fever and chills,*Night sweats (these correlate with a worse prognosis, B sx’s) -Fatigue and weakness –Tachycardia Diagnosis

11. Lymphoma – Hodgkin’s Treatment: Based on stage of the disease –Radiation alone or with chemotherapy Objective: –least amt of tx to achieve cure yet minimize short-term & long-term complications Nursing Management –pain control –managing side effects –psychosocial support

12. Non-Hodgkin’s Lymphomas Patho Prevalence Categories –Low grade (indolent) –Intermediate grade (aggressive) –High grade (very aggressive) Affects all ages Manifestations

13. Non-Hodgkin’s lymphomas Diagnosis Treatment –Radiation if just stage I –Chemotherapy involves multidose/multiagent regimen –Holistic nursing management-same as previous blood disorders…pain control, management of SE, psychosocial support, –Spiritual care-multidisciplinary team

14. Multiple Myeloma Patho excess production of plasma cells w/resultant myeloma proteins destroys bone/bone marrow Incidence Clinical manifestations (develop slowly and insidiously) –Skeletal pain (esp pelvis, spine & ribs) *Major manifestation, presents first. –Osteolytic lesions; can see in skull, vertebrae & ribs –Hypercalcemia from bony degeneration –Anemia, thrombocytopenia, & granulocytopenia

15. Multiple Myeloma Diagnosis Lab, x-rays, bone marrow Urine has Bence Jones protein Collaborative management: –Radiation –Chemo Nursing Management –Ambulation & adequate hydration –Ambulate w/care –Pain control –Infection control –Emotional/spiritual support