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Leukemia (ASSESSMENT (GI (Weight loss, nausea, anorexia, INC RF bleeding-…

- - - - lympho -cytic/-blastic
        
        lymphatic pathway
      - myelo -cytic/-blastic
        
        myeloid pathway
    - - Acute
        
        sudden onset
      - Chronic
        
        slow onset and manifestations that persist for years
- - - - Excessive production of ABN cells in the BM stops RBC/PLT/mature WBC production
        
        Anemia, thrombocytopenia, and leukopenia occurs
        
        :!!:INC RF infection/bleeding :!!:
        
        :!!:Infection, Hemorrhage, Death:!!:
        
        ABN and IM WBCs do not provide protection
- - - - any large amount INCs risk; esp. AML
- - - - 25% all leukemias; 80% of all adult leukemias
    - - Infection, bleeding, hyperplasia BM/Spleen
  - - - Abrupt
        
        Fever/ Bleeding
      - Insidious
        
        progressive weakness, fatigue, pain, bleeding, CNS manifestations due to CSF infestation. INC ICP --> seizures, headaches, vomiting
  - - - 3 Phases
        
        Chronic- may not be aware it is present. Slow growth, mild manifestations, well controlled, responds to tx (symptom management)
        
        Accelerated- symptomatic, night sweats, spleen enlargement, unexplained weight loss, does not respond to tx. Rapid growth, severe manifestations, INC blast cells. Lasts 6-12mos
        
        Blast- aggressive with high amounts of blast/promyelocytes that spread to other organs; aggressive tx
      - Often Philadelphia Chromosome (+); considered genetic hallmark/marker; present in >90-95% CML cases
  - - - Production/accumulation of long-living lymphocytes that are inactive
        
        B Cells involved; lymphadenopahty present
      - Most common adult leukemia- Big Q: can they handle tx and the SE based on age/health
        
        Survival extended if dx in early stage
      - Complications
        
        Early stage= Rare
        
        Develop as disease progresses
        
        Pain and paralysis
        
        Caused by INC pressure from lymph node enlargement
- - - - WBC count, esp w/ blast cells, the poorer the prognosis
- - - - PREP
        
        Accurate info, emotional support, anti-anxiety meds
      - PROCEDURE
        
        5-15mins, local anesthetic, rapid-acting sedative
      - FOLLOW-UP
        
        Inspect site for bleeding Q2H X 24H, ice packs for inflammation, :forbidden:Contact sports/activity X 48H
- - - - Goal: Achieve rapid, complete remission(<5% blast cells present)
      - Causes severe BM suppression and stops new production. "Wiped out"
        
        2-3 week recovery
        
        Older patients may have harder time fighting infection during induction
      - 70% gain remission after 1st dose
  - - - Can receive inactivated polio