LEUKIMIA

Ns. Ayu Nanda Lestari, M.Kep

 DEFINITION
• A group of malignant disorders affecting the blood and blood-forming tissues of
• Bone marrow
• Lymph system
• Spleen
• Leukemia is a neoplastic proliferation of one particular cell type (granulocytes, monocytes,
lymphocytes, or infrequently erythrocytes or
megakaryocytes). Occurs in all age groups
 ETIOLOGY AND
PATHOPHYSIOLOGY
• No single causative agent
• Most from a combination of factors
• Genetic and environmental influences
• Associated with the development of leukemia
• Chemical agents
• Chemotherapeutic agents
• Viruses
• Radiation
• Immunologic deficiencies
 CLASSIFICATION
• Acute versus chronic
• Cell maturity
• Acute: clonal proliferation of immature hematopoietic cells (the formation of blood or blood cells )
• Chronic: mature forms of WBC; onset is more gradual
• Nature of disease onset
• Type of white blood cell (WBC)
• Acute lymphocytic leukemia (ALL)
• Acute myelogenous leukemia (AML)
• Also called acute nonlymphoblastic leukemia (ANLL)
• Chronic myelogenous leukemia (CML)
• Chronic lymphocytic leukemia (CLL)
 ACUTE MYELOGENOUS LEUKEMIA
(AML)
•AML results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells:
monocytes, granulocytes (eg, neutrophils, basophils, eosinophils), erythrocytes, and platelets
•AML is the most common nonlymphocytic leukemia
•Clinical manifestasion
•Fever and infection (result from neutropenia)
•weakness and fatigue (from anemia)
•bleeding tendencies (from thrombocytopenia)
•pain from an enlarged liver or spleen
•hyperplasia of the gums
•bone pain from expansion of marrow
•Complications of AML include bleeding and infection, the major causes of death
 Chronic myelogenous leukemia (CML)

• Chronic myeloid leukemia (CML) arises from a mutation in the myeloid stem cell
• CML is uncommon in people younger than 20 years of age; the incidence increases with age (mean age is 67 years)
• Clinical Manifestasion :
• short of breath or slightly confused because of decreased capillary perfusion to
the lungs and brain from leukostasis (the excessive volume of leukocytes inhibits blood flow through the capillaries)
• The patient may have an enlarged, tender spleen. The liver may also be enlarged
• malaise, anorexia, and weight loss
• Lymphadenopathy is rare
• Problems with infections and bleeding are rare
 ACUTE LYMPHOCYTIC LEUKEMIA
(ALL)
• Most common type of leukemia in children
• 15% of acute leukemia in adults
• Immature lymphocytes proliferate in the bone marrow
• Signs and symptoms may appear abruptly
• Fever, bleeding
• Insidious with progressive
• Weakness, fatigue
• Central nervous system manifestations
 CHRONIC LYMPHOCYTIC
LEUKEMIA (CLL)
• Production and accumulation of functionally inactive but long-lived, mature-appearing
lymphocytes
• B cell involvement
• Lymph node enlargement is noticeable throughout the body
• ↑ incidence of infection
• Complications from early-stage CLL is rare
• May develop as the disease advances
• Pain, paralysis from enlarged lymph nodes causing pressure
 CLINICAL MANIFESTATIONS
• Relate to problems caused by
• Bone marrow failure
• Overcrowding by abnormal cells
• Inadequate production of normal marrow elements
• Anemia, thrombocytopenia, ↓ number and function of WBCs
• Relate to problems caused by
• Leukemic cells infiltrate patient’s organs
• Splenomegaly
• Hepatomegaly
• Lymphadenopathy
• Bone pain, meningeal irritation, oral lesions (chloromas)
 DIAGNOSTIC STUDIES
• To diagnose and classify
• Peripheral blood evaluation (CBC and blood smear)
• Bone marrow evaluation
• To identify cell subtype and stage
• Morphologic, histochemical, immunologic, and cytogenic methods
 COLLABORATIVE CARE
• Goal is to attain remission (when there is no longer evidence of cancer cells in the body)
• Chemotherapeutic treatment
• Induction therapy
• Attempt to induce or bring remission
• Seeks to destroy leukemic cells in the tissues, peripheral blood, bone marrow
• Patient may become critically ill
• Provide psychological support as well
 NURSING PROCESS
• Assessment
• Although the clinical picture varies with the type of leukemia as well as the treatment implemented, the health
history may reveal a range of subtle symptoms reported by the patient before the problem is detectable on
physical examination

• systematic assessment incorporating all body systems is essential. For example, a dry cough, mild dyspnea,
and diminished breath sounds may indicate a pulmonary infection

• The platelet count can become dangerously low, leaving the patient at risk for significant bleeding

• The nurse also must closely monitor the results of laboratory studies
 NURSING DIAGNOSIS
Based on the assessment data, major nursing diagnoses for the patient with acute leukemia may include:

• Risk for infection and bleeding

• Risk for impaired skin integrity related to toxic effects of chemotherapy, alteration in nutrition, and impaired mobility
• Impaired gas exchange
• Impaired mucous membranes due to changes in epithelial lining of the GI tract from chemotherapy or prolonged use of antimicrobial
medications
• Imbalanced nutrition, less than body requirements, related to hypermetabolic state, anorexia, mucositis, pain, and nausea
• Acute pain and discomfort related to mucositis, leukocyte infiltration of systemic tissues, fever, and infection
• Hyperthermia related to tumor lysis or infection
• Fatigue and activity intolerance related to anemia, infection, and deconditioning
• Impaired physical mobility due to anemia, malaise, discomfort, and protective isolation
• Risk for excess fluid volume related to renal dysfunction, hypoproteinemia, and need for multiple IV medications and blood products
• Diarrhea due to altered GI flora, mucosal denudation, and prolonged use of broad-spectrum antibiotics
• Risk for deficient fluid volume related to potential for diarrhea, bleeding, infection, and increased metabolic rate
• Self-care deficit due to fatigue, malaise, and protective isolation
• Anxiety due to knowledge deficit and uncertainty about future
• Disturbed body image related to change in appearance, function, and roles
• Grieving related to anticipatory loss and altered role functioning
• Potential for spiritual distress
• Deficient knowledge about disease process, treatment,complication management, and self-care measures
 NURSING MANAGEMENT
PLANNING
•Overall goals
•Understand and cooperate with the treatment plan
•Experience minimal side effects and complications of disease and treatment
•Feel hopeful and supported during the periods of treatment, relapse, and remission
•Many physical and psychological needs
•Evokes great fear
• Family also needs help
•Balance demanding technical needs with a humanistic, caring approach
•Patient empowered by knowledge of the disease and treatment can have a more positive outlook and improved quality of life
•Nurses face special challenges when meeting the intense psychosocial needs of a patient with leukemia
•Preventing or Managing Infection and Bleeding, Managing Mucositis, Improving Nutritional Intake, Easing Pain and
Discomfort
•Decreasing Fatigue and Deconditioning, Maintaining Fluid and Electrolyte Balance
• Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse
• Teach patient and significant other
• Diligence in disease management
• Need for follow-up care
• When to seek medical attention
• Goals of rehabilitation
• Manage
• Physical
• Psychosocial
• Social
• Spiritual
• Delayed effects
• Support groups
 NURSING MANAGEMENT
EVALUATION
• Cope effectively with diagnosis, treatment regimen, and prognosis
• Attain and maintain adequate nutrition
• Experience no complications
• Feel comfortable and supported