Leukemia-Lymphoma-Multiple-Myeloma

							      Leukemia
         &
     Lymphoma
Keith Rischer, RN, MA, CEN
                          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
    • 5 yr survival 80% peds/40% w/adults
  Chronic lymphocytic leukemia (CLL)-most common w/adults
    • 73% survival rate
Myelogenous leukemia
  Acute myelogenous leukemia (AML) 20% survival rate
  Chronic myelogenous leukemia (CML)
          Leukemia: Etiology
•   Chromosomal changes
•   Chemical Agents-Benzene
•   Chemotherapy-Alkylating Agents
•   Viruses-Retroviruses
•   Radiation
•   Unknown factors
             Leukemia Sx-
Clinical Manifestations
  –   Anemia
  –   Fatigue and weakness
  –   Bleeding
  –   Fever and Infections
  –   Weight loss-joint pain
  –   Mouth sores
  –   Hepatosplenomegaly & Lymphadenopathy
      Diagnosis
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
       Nursing Management
Acute
 Many emotional-psychosocial
 needs/support
  – Communicate tx plan-expected course
  – Protective Isolation/Neutropenic Precautions
  – Educate!!
  – Chemo-manage side effects
  – Spiritual care
                  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
              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.
        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
      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
  Non-Hodgkin’s Lymphomas

Patho
Prevalence
Categories
  – Low grade (indolent)
  – Intermediate grade (aggressive)
  – High grade (very aggressive)
     • Affects all ages
  Manifestations
   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
                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
             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