MS.C.MARY LALITHA KALA ASSISTANT PROFESSOR, MEDICAL AND SURGICAL NURSING ANRI COLLEGE OF NURSING VISAKHAPATNAM

1. MS.C.MARY LALITHA KALA
LECTURER, MEDICAL AND SURGICAL
NURSING
G.S.L COLLEGE OF NURSING
RAJAHMUNDRY

2. DEVELOPMENT OF NORMAL BLOOD
CELLS

3. FUNCTION OF WBC
1.NUETROPHILS:
INFLAMMATORY REACTION WITHIN 1 HOUR
2.MONOCYTES:
SEOND LINE OF DEFENSE.
3.MACROPHAGES:
EFFECTIVE AGAINST FUNGAL AND VIRAL AGENTS.
4.EOSINOPHILS AND BASOPHILS:
HYPERSENSITIVITY REACTIONS.
5.LYMPHOCYTES:
HUMORAL AND CELLULAR IMMUNITY.

4. DEFINITION
“IT IS AN UNCONTROLLED PROLIFERATION OF
WHITE BLOOD CELLS MOSTLY INVOLVING
THE DEVELOPMENT OF IMMATURE ,
DYSFUNCTIONAL WBC”.

5. TYPES OF LEUKEMIA
LUEKEMIA
MYELOID LYMPHOID
ACUTE CHRONIC ACUTE CHRONIC

6. LEUKEMIAS

7. 1.ACUTE MYELOID LEUKEMIA
RESULTS FROM THE DIFFERENTIATION OF THE
STEM CELL INTO ALL MYELOID CELLS
INCIDENCE:
 ALL AGE GROUPS.
 PEAK AT 60 YEARS.

8. CLINICAL MANIFESTATIONS
NUETROPENIA
ANEMIA
THROMBOCYTOPENIA
PROLIFERATION OF LEUKEMIC CELLS IN
ORGANS
HYPERPLASIA OF GUMS
BONE PAIN

9. ASSESSMENT AND DIAGNOSTIC
FINDINGS
1. COMPLETE BLOOD COUNT.
DECREASED ERYTHROCYTE AND
PLATELET COUNT
2. BONE MARROW ANALYSIS.

10. COMPLICATIONS
BLEEDING
INFECTION
ECCHYMOSIS
PETECHAEI

11. MEDICAL MANAGEMENT
1 INDUCTION:
CYTARABINE
DAUNORUBUCIN
MITOXANTRONE
IDARUBUCIN.
2 CONSOLIDATION THERAPY
BONE MARROW TRANSPLANTATION
PERIPHERAL BLOOD STEM CELL TRANSPLANTATION

12. 2.CHRONIC MYELOID LUEKEMIA
• ARISE DUE TO A MUTATION IN MYELOID STEM
CELL RESULTING IN THE FORMATION OF
PREMATURE OR IMMATURE FORMS.
• MUTATION:
BRC gene 22 + ABL gene 9
ORAL TYROSINE KINASE PROTEIN IS FORMED
RAPID DIVISION OF WBC

13. CLINICAL MANIFESTATIONS
MOSTLY ASYMPTOMATIC
WBC > 100,000/mm3
_shortness of breath
_slightly confused
_enlarged tender spleen
_malaise, anorexia, weight loss.

14. STAGES OF CML
3 STAGES ARE PRESENT:
 CHRONIC
 TRANSFORMATION
 ACCELERATED STAGE/BLAST CRISIS.

15. MEDICAL MANAGEMENT
ORAL TYROSINE KINASE INHIBITORS
CONVENTIONAL THERAPY:
_INTEREFON ALPHA
_CYTOSINE
LESS AGGRESSIVE THERAPY
_HYDROXY UREA
_BUSALFAN

16. 3.ACUTE LYMPHOCYTIC LEUKEMIA
RESULTS FROM AN UNCONTROLLED
PROLIFERATION OF IMMATURE CELLS
(LYMPHOBLAST)DERIVED FROM LYMPHOID STEM
CELL
B Lymphocyte-75%
T Lymphocyte_25%
INCIDENCE:
 COMMON IN YOUNG CHILDREN
 PEAK INCIDENCE IN 4 YEARS

17. PATHOPHYSIOLOGY AND CLINICAL
MANIFESTATIONS
IMMATURE LYMPHOCYTES PROLIFERATE IN THE BONE
MARROW
CROWD THE DEVELOPMENT OF NORMAL MYELOID CELLS
INHIBITION OF NORMAL HEMATOPOEISIS
RESULTS IN REDUCED NUMBER OF
luekocytes erythrocytes platelets

18. MEDICAL MANAGEMENT
 INDUCTION THERAPY:
1. INTRA THECAL CHEMOTHERAPY
_METHOTREXATE.
2. CORTICOSTEROIDS.
 MAINTAINANCE PHASE:
CHEMOTHERAPUETIC AGENTS FOR 3 YEARS.

19. 4 CHRONIC LYMPHOCYTIC LEUKEMIA
COMMON MALIGNANCY OF OLDER ADULTS
INCIDENCE MORE IN PEOPLE OLDER THAN 60
YEARS OF AGE

20. PATHOPHYSIOLOGY
A MALIGNANT CLONE OF B LYMPHOCYTE (T LYMPHOCYTE IS
RARE)
FEATURES MATURE WBC WITH ANTIGEN CD 52
ESCAPES APOPTOSIS
EXCESSIVE ACCUMALATION OF THE CELLS IN THE MARROW
AND CIRCULATION
LYMPHOCYTE COUNT >100,000mm3
( diagnostic evaluation)

21. CLINICAL MANIFESTATION
LYMPHADENOPATHY
HEPATOMEGALY
SPLEENOMEGALY
CONSTELLATION OF SYMPTOMS
 _FEVER
 _DRENCHING SWEATING
 _UNINTENSIONAL WEIGHTLOSS
 DEFECT IN CELL MEDIATED AND HUMORAL
MEDIATED IMMUNITY
 ANERGY

22. MEDICAL MANAGEMENT
REQUIRES NO TREATMENT
IF SYMPTOMS SEVERE
 _CHEMOTHERAPY
CORTICOSTEROID
CHLORAMBUCIL
CYCLOPHOSPHAMIDE
VINCRISTIN
DOXORUBUCIN

23. NURSING MANAGEMENT

24. NURSING DIAGNOSIS
1. RISK FOR INFECTION AND BLEEDING
2. RISK FOR IMPAIRED SKIN INTEGRITY
IMBALANCED NUTRITION: LESS THAN
BODY REQUIREMENTS
3. FATIGUE AND ACTIVITY INTOLERANCE
4. RISK FOR DEFICIT FLUID VOLUME
5. ANXIETY DUE TO KNOELEDGE DEFICIT

25. NURSING INTERVENTIONS

26. 1. PREVENTING /MANAGING
INFECTION AND BLEEDING
1. HAND WASHING
2. PREVENT INJURIES /FALLS
3. MAINTAIN STERILE AND ASEPTIC TECHNIQUES

27. 2. IMPROVING NUTRITIONAL INTAKE
1. MOUTHCARE BEFORE AND AFTER MEALS
2. SMALL FREQUENT FOODS WHICH ARE SOFT
IN TEXTURE MODERATE IN TEMPERATURE

28. 3. EASING PAIN AND DISCOMFORT
1. ACETAMINOPHEN
2. GENTLE BACK AND SHOULDER MASSAGE
3. FREQUENT CHANGING OF BED CLOTHES

29. 4.MAINTAINING FLUID AND
ELECTROLYTE BALANCE
1. INTAKE AND OUTPUT TO BE MEASURED
ACCURATELY
2. REPLACEMENT OF ELECTROLYTES
PARTICULARLYPOTASSIUM AND MAGNESIUM

30. 5. TEACHING SELF CARE
1. SELF IDENTIFICATION OF SIGNS AND SYMPTOMS
2. FOLLOWING THE MEDICATION REGIMEN
ACCURATELY
3. FOLLOWING ADEQUTE HYGIENIC MEASURES AT
HOME.

31. QUESTIONS TIME
?

32. 1. WHICH CELL IS INVOLVED IN LEUKEMIA?
2. WHAT IS THE CELL WHICH GIVES RISE TO ALL
THE CELLS?
3. WHAT IS LEUKEMIA ?
4. WHAT IS ACUTE MYELOID LEUKEMIA
5. WHAT MUTATION OCCURS IN CHRONIC
MYELOID LEUKEMIA?

33. 6. WHAT ARE THE STAGES OF CML?
7. WHICH CELL IS INVOLVED MORE IN ALL?
8. WHAT IS THE MEDICAL Rx FORALL?
9. WBC ESCAPE APOPTOSIS IN WHICH TYPE OF
LEUKEMIA?
10. NURSING MANAGEMENT FOR A LEUKEMIC
CLIENT?

34. ANSWERS
1. WBC.
2. MULTIPOTENT STEM CELL.
3. IT IS AN UNCONTROLLED PROLIFERATION
OF WHITE BLOOD CELLS MOSTLY
INVOLVING THE DEVELOPMENT OF
IMMATURE , DYSFUNCTIONAL WBC.
4. RESULTS FROM THE DIFFERENTIATION OF
THE STEM CELL INTO ALL MYELOID CELLS

35. 5. MUTATION:
BRC gene 22 + ABL gene 9
ORAL TYROSINE KINASE PROTEIN IS FORMED
RAPID DIVISION OF WBC

36. 6. THREE STAGES ARE PRESENT:
 CHRONIC, TRANSFORMATION,
ACCELERATED STAGE/BLAST CRISIS.
7. B LYMPHOCYTE.
8. INDUCTION THERAPY:
1. INTRA THECAL CHEMOTHERAPY
_METHOTREXATE.
2. CORTICOSTEROIDS.
MAINTAINANCE PHASE:
CHEMOTHERAPUETIC AGENTS FOR 3 YEARS.

37. 9. CLL
10.
 PREVENTING/ MANAGING BLEEDING AND
INFECTION.
IMPROVING NUTRITIONAL INTAKE
EASING PAIN AND DISCOMFORT
MAINTAINING FLUID AND ELECTROLYTE
IMBALANCE
TEACHING SELF CARE