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ACUTE LYMPHOID LEUKEMIA (ALL) - Coggle Diagram
ACUTE LYMPHOID LEUKEMIA (ALL)
CAUSES
Neoplastic monoclonal proliferation of lymphoid stem cells in bone marrow
Immature lymphoblasts accumulate in bone marrow → physical suppression → prevent maturation
TYPES
B cell acute lymphoblastic leukemia (B-ALL)
Most common
Origin: Pre-B cells of bone marrow
Associated with translocations t(12,21), t(9,22)
T cell acute lymphoblastic leukemia (T-ALL)
Origin: Pre-T cells in thymus
Associated with NOTCH1 mutation
CLINICAL MANIFESTATIONS
Tachycardia. As the oxygen-carrying component of the blood decreases, the body compensates by pumping out blood faster than normal.
Fatigue. The patient experiences fatigue more frequently than normal.
Anemia. Anemia is present in ALL because of a decrease in mature RBCs.
Dyspnea. A decrease in the mature blood components leads to dyspnea.
Bruising. Easy bruising after minor trauma is a sign of leukemia.
High fever. High fever accompanied by thrombocytopenia and abnormal bleeding (such as nosebleeds and gingival bleeding) manifests in the patient.
TREATMENT
MEDICATIONS:
If spread to brain
Intrathecal chemotherapy/radiation therapy
Tyrosine-kinase inhibitors
Aggressive chemotherapy with prophylactic injections to scrotum, cerebrospinal fluid (CSF)
More successful in children > two years old
95% complete remission, 75% cure rate
NURSING DIAGNOSIS
Risk for infection related to overproduction of immature WBCs.
Risk for impaired skin integrity related to toxic effects of chemotherapy, alteration in nutrition, and impaired immobility.
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.
NURSING MANAGEMENT
The care plan for the leukemic patient should emphasize comfort, minimize the adverse effects of chemotherapy, promote preservation of veins, manage complications, and provide teaching and psychological support.