Leukemia.pptx

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1. Leukemia

2. Introduction: Leukemia describes a group of malignant disorders in which uncontrolled proliferation of leucocyte in the bone marrow infiltrate the blood forming tissues of the bone marrow, lymph system, liver and spleen. Leukemia occurs in all age groups. 7/24/2019 Chandan Pradhan 2

3. DEFINITION: Leukemia is a malignant disease of blood forming organs of the body that results in uncontrolled growth of immature white blood cells. 7/24/2019 Chandan Pradhan 3

4. INCIDENCE : In India the incidence of leukemia's is 3-4 per 1,00,000 population. 30-52% of all childhood cancers in males and 19-52% in females in India. Approximately 26500 occur in adults 7/24/2019 Chandan Pradhan 4

5. Etiology: In general no causative agents. Leukemias result from a combination of genetic factors and environmental factors Chemical agents, chemotherapeutic agents, viruses, radiation and immunologic deficiency are associated with development of leukemia Radiations near nuclear reactor causes leukemia 7/24/2019 Chandan Pradhan 5

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7. Classification: Acute myelogenous leukemia (AML) Acute lymphocytic leukemia (ALL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL) 7/24/2019 Chandan Pradhan 7

8. 1. AML Age of onset : 60-70 years of age Clinical Manifestations : Fatigue and weakness Headache Mouth sores Anemia Diagnostics : Low RBC count , 7/24/2019 Chandan Pradhan 8

9. 2. ALL Age of onset : Before 14 years Clinical manifestations : Fever, Pallor, Bleeding , Increased ICP Diagnostics : high WBC 7/24/2019 Chandan Pradhan 9

10. 3. CML Age of onset : 25-60 years Clinical manifestations : sternal tenderness, weight loss, joint pain, excessive perspiration Diagnostics : High platelet count early and lower later Increased polymorphoneuclear neutrophils 7/24/2019 Chandan Pradhan 10

11. 4. CLL Age of onset : 50-70 years Clinical manifestations : Anorexia, Splenomegaly, Night sweats, Weight loss. Diagnostics : Mild anemia and thrombocytopenia, Increased lymphocytes. 7/24/2019 Chandan Pradhan 11

12. Pathophysiology : 7/24/2019 Chandan Pradhan 12

13. Acute lymphocyte leukemia is malignant disorder arising from a single lymphoid stem cell, with impaired maturation and accumulation of the malignant cells in the bone marrow. Diagnosis is confirmed by bone marrow aspiration or biopsy, which typically shows different stages of lymphoid development. Very immature cells forms. The greater the number of immature cells, the poorer will be the prognosis.

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15. Clinical manifestations: Anaemia from decreased RBCs Infection from neutropenia Bleeding from decreased platelet production Fever Weakening of the bone Fractures Spleen and liver enlargement 7/24/2019 Chandan Pradhan 15

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17. Diagnostic evaluation: History collection Physical examination Peripheral blood smear (immature forms of leukocytes) Bone marrow aspiration or biopsy. Lumbar puncture is performed to determine if there is any CNS involvement. 7/24/2019 Chandan Pradhan 17

18. Management Treatment of leukemia involves the use of chemotherapeutic agents, with or without any of these four phases: 1. Induction therapy 2. CNS prophylactic therapy 3. Intensification therapy 4. Maintenance therapy 7/24/2019 Chandan Pradhan 18

19. 1. Induction therapy: Induction aims at eradication of all leukemia blast cells, which permits the return of normal hematopoiesis. A number of genetic or drug combinations are used. The most common dug is prenizolone and vincristile . 7/24/2019 Chandan Pradhan 19

20. 2. CNS prophylactic therapy: Treatment of the CNS consists of prophylactic therapy using intrathecal chemotherapy with methotrexate, cytarbine and hydrocortisone. 7/24/2019 Chandan Pradhan 20

21. 3. Intensification or consolidation therapy: After complete induction is obtained, a period of intensified treatment is administered to eradicate residual leukemic cells, this is followed by delayed intensification to prevent emergence of resistant leukemia clones. Chemotherapy including high dose or intermediate dose methotrexate, cytarbine is administered over a period of several months. 7/24/2019 Chandan Pradhan 21

22. 4. Maintenance therapy: For maintenance therapy drugs like, metropercate cyclophosphemide . Also during maintenance therapy, periodic Complete blood screening is done to evaluate the bone marrow’s response to the drugs. 7/24/2019 Chandan Pradhan 22

23. Nursing management: Give psychological support to the family members Encourage child to talk about feelings Help family as they encourage child to express feelings Give pain relief therapy Avoid pressure on painful areas Keep fresh air circulating in room 7/24/2019 Chandan Pradhan 23

24. Nursing diagnosis : 1. Risk for infection related to neutropenia from the disease process and treatment Intervention Follow the strict aseptic technique for hand washing procedure. Monitor the vital signs frequents for signs of infection. Administer antibiotics as ordered. To minimize exposure to infective organism. 7/24/2019 Chandan Pradhan 24

25. Contd.. 2. Risk for injury related to thrombocytopenia Intervention: Monitor susceptibility to bleeding Assess for signs of bleeding including petechial and bruising Monitor urine and stool for signs of occult bleeding Do the platelet count daily 7/24/2019 Chandan Pradhan 25

26. Contd.. Decreased platelet count bruising, petechial and blood in urine or stool can indicate bleeding Monitor for signs of haemorrhage (Decreased BP, tachycardia, pallor, diaphoresis restlessness) Avoid skin punctures when possible. Apply pressure if punctures necessary for 5 – 10 minutes Children with platelet counts below 20000/mm3 are at risk for spontaneous bleeding 7/24/2019 Chandan Pradhan 26

27. Contd.. 3. Pain related to diagnosis, disease process and treatment. Intervention: Assess the painful areas for location, severity and signs of infection. Provide pain medication Provide psychological support Give play therapy Follow the doctors order 7/24/2019 Chandan Pradhan 27

28. Contd.. 4. Imbalanced nutrition : less than body requirement related to loss of appetite nausea, vomiting and mucositis . Intervention: Give small amount of food frequently Encourage high protein and high calorie diet Give food as per patient like and dislikes Administer antiemetics as ordered to decrease nausea 7/24/2019 Chandan Pradhan 28