CASE PRE- Acute Lymphoblastic Leukemia

8/3/2019 CASE PRE- Acute Lymphoblastic Leukemia

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ACUTE LYMPHOBLASTIC LEUKEMIA

Michelle Agte, RN

Daniel Villardo Biscocho, RN

Alger Vidallon, RN


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ACUTE LYMPHOBLASTIC LEUKEMIA

IntroductionCauses

Risk Factors

Symptoms

Diagnostic Tests

Treatment


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INTRODUCTION

Acute lymphoblastic leukemia (ALL) is a type

of cancer of the blood and bone marrow

the spongy tissue inside bones where blood

cells are made.

The word "acute" in acute lymphocytic

leukemia comes from the fact that the disease

progresses rapidly and affects immature bloodcells, rather than mature ones.


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INTRODUCTION

The "lymphoblastic" in acute lymphoblastic

leukemia refers to the immature white blood

cells called lymphoblast, which ALL affects.

Acute lymphoblastic leukemia is also known as

acute lymphocytic leukemia and acute

childhood leukemia.


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INTRODUCTION

WBCs evolve from immature cells referred to asblasts. Malignancy of these blast cells is the

source of leukemias, which generally progresses

as follows: Normally, blasts constitute 5% or less of healthy bone

marrow. In leukemia, however, these blasts remain

immature and multiply continuously, eventually

constituting between 30 - 100% of the bone marrow.

Eventually these malignant blast cells fill up the bone

marrow and prevent production of healthy red cells,

platelets, and mature white cells (leukocytes).


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INTRODUCTION

They spill out of the marrow into the

bloodstream and lymph system and can travel

to the brain and spinal cord (the central

nervous system). As the number of normal

cells decline, dangerous symptoms develop,

which, if untreated, become lethal.


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INTRODUCTION

Leukemias are divided into two major types:

Acute (which progresses quickly with many

immature white cells)

Chronic (which progresses more slowly and has

more mature white cells)


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INTRODUCTION

Acute lymphblastic leukemia is the most

common type of cancer in children, and

treatments result in a good chance for a cure.

ALL can also occur in adults, though the

prognosis is not as optimistic.


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CAUSES

The causes of the disease are not known, but

researchers believe that ALL develops from a

combination of:

genetic,

biologic, and

environmental factors.


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RISK FACTORS

Age and Sex

Race and ethnicity

Heredity disorders Radiation and Chemical Exposure


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RISK FACTORS

Age and Sex

ALL is the most common type of cancer diagnosed

in children. ALL accounts for about 75% of cases of

childhood leukemia. ALL can strike children of allages, but is most likely to occur when children are

2 - 4 years of age. It is slightly more common in

boys than in girls.


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RISK FACTORS

Age and Sex

Race and ethnicity



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RISK FACTORS

Race and ethnicity

Caucasian and Hispanic children have a higher risk

for ALL than African-American children.


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RISK FACTORS

Age and Sex

Race and ethnicity



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RISK FACTORS

Heredity disorders


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RISK FACTORS

Heredity disorders

ALL does not appear to run in families. But certain

inherited genetic disorders may increase risk. For

example, children with Down syndrome have a 20-times greater risk of developing ALL than the

general population.


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RISK FACTORS

Age and Sex

Race and ethnicity



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RISK FACTORS

Radiation and Chemical Exposure

Previous cancer treatment with high doses of

radiation or chemotherapy can increase the risk

for developing ALL. Prenatal exposure to x-raysmay also increase risk in children. Lower levels of

radiation (living near power lines, video screen

emissions, small appliances, cell phones) are

unlikely to pose any cancer risk.


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SYMPTOMS

Generalized weakness and fatigue

Anemia

Frequent or unexplained fever and infections

Weight loss and/or loss of appetite

Excessive and unexplained bruising

Bone pain, joint pains

Breathlessness Enlarged lymph nodes, liver and/or spleen

Petechiae


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TREATMENT

Chemotherapy

Radiation Therapy

Blood and Bone Marrow Transplant


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ALL: A CASE STUDY

Nursing Health History


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NURSING HEALTH HISTORY

Assessment


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BIOGRAPHIC DATA

Name: CAge: 12 years old

Gender: Male

Religion: Roman CatholicAddress: San Pedro St., Alaminos, Laguna

--------------------------------------------------------------------

Date and Time of Admission:

November 23, 2010 / 11:14 am

Attending Physician: Dr. Castillo

Consultant: Dra. Salvador, Hematologist


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HISTORY OF PRESENT ILLNESS

5 (Five) days prior to admission, patientmanifested hematoma and bruises on both

upper and lower extremities associated with

gingival bleeding upon brushing of teeth. Noconsultation done.

3 (Three) days prior to admission, patient

developed moderate grade fever associatedwith decrease of appetite and body weakness.

Mother claims that patient has episodes of

epistaxis. No consultation done.


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HISTORY OF PRESENT ILLNESS

Few hours prior to admission, persistence of

above condition, prompt patient to consult at

Dr. Castillos Clinic (Pediatrician). Hence,

advised for admission at St. Cabrini MedicalCenter and Cancer Institute under his service.


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PAST HISTORY

Patient had previous hospitalization due to

Bronchopneumonia (February 2010) and

Appendicitis (Appendectomy, August 2010).

Patient has no allergies to drug, foods, or

other environmental agents.


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FAMILY HISTORY

Patient has family history of Anemia and

Leukemia on maternal side as claimed by his

mother.

One of his uncles died with Leukemia.


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LIFESTYLE

Nutrition and Metabolism: He eats 3x a dayand drinks water approximately 5 glasses a

day. During the hospitalization, he was on a

diet as tolerated except dark-colored foodsregimen. The mother claimed her son has

improved his appetite for he was able to

consume 80 90% of meal served.


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LIFESTYLE

Elimination: During the hospitalization,patients elimination was monitored andrecorded. He defecated 3x with normal

characteristics of bowel, no hematochezia normelena noted. He voided spontaneouslywithout experiencing discomfort, nohematuria noted.

Activity and Exercise: During thehospitalization, the patient was advised tofollow a complete bed rest regimen.


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PHYSICAL ASSESSMENT


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SKIN

Skin is pale.

He has hematoma and bruises on both upper

and lower extremities.

With no signs of dehydration.


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NAILS

Nail plates on fingernails of both hands are

slightly pale

Capillary Refill Test < 3 seconds.


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HEAD AND NECK

Head is normocephalic and symmetrical with

frontal, parietal, and occipital prominences.

Black hair is evenly distributed with no

infestations noted.

With eyes slightly protruding.

An enlarged left cervical lymph node is

palpable, non-tender.


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RESPIRATORY

No nasal flaring nor difficulty of breathing

noted.

No cough and colds as claimed by the patient.

With clear breath sounds on both lungs heard

upon auscultation.

No respiratory depression noted.


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GENITOURINARY

Patient voids spontaneously and reported no

discomfort.

No flank pain as claimed.

No urinary frequency nor urgency as claimed.


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Hematoma and bruisesallor

Hematoma and bruises

Enlarged lymph node

Body weakness


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ANATOMY AND PHYSIOLOGY

BLOOD AND MARROW


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NORMAL BLOOD AND MARROW

Blood is composed ofplasma and cells suspendedin plasma.

The plasma is largely made up of water in which

many chemicals are dissolved. These chemicalsinclude:

Proteins (such as albumin) Hormones (such as thyroid hormone)

Minerals (such as iron) Vitamins (such as folate) Antibodies, including those we develop fromour vaccinations (such as poliovirus antibodies).


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The cells suspended in plasma include red

cells, platelets and white cells (neutrophils,

eosinophils, basophils, monocytes and

lymphocytes)


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RED BLOOD CELLS (Erythrocytes)

The red cells are tiny biconcave disks, thin in the

middle and thicker around the periphery.

The red cells make up half the volume of theblood. They are filled with hemoglobin, the

protein that picks up oxygen in the lungs and

delivers oxygen to the cells all around the body.


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PLATELETS (Thrombocytes)

The platelets are small cells (one-tenth the size of

red cells) that help stop bleeding at the site of an

injury in the body. They become sticky and clump together to form

platelet plugs that close breaks and tears in blood

vessels.


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WHITE BLOOD CELLS (Leukocytes)

The white cells serve as bodys defense and

immune system.

NEUTROPHILS phagocytize microorganisms and otherforeign substances.

BASOPHILS release histamine and other chemicals that

promote inflammation

EOSINOPHILS release chemicals that reduceinflammation and destroys certain parasites.


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WHITE BLOOD CELLS (Leukocytes)

The white cells serve as bodys defense and

immune system.

LYPHOCYTES are responsible for specific immuneresponses: involve in the production of antibodies,

contribute to allergic reactions, rejects grafts, control

tumors, and regulate the immune system.

MONOCYTES enlarge and become MACROPHAGESwhich phagocytize bacteria, dead cells, cell fragments,

and any other debris within the tissue.


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BLOOD

Transports gases, nutrients, metabolic wastes,

blood cells, immune cells, and hormones

throughout the body.


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MARROW

Marrow is a spongy tissue where blood celldevelopment takes place.

It occupies the central cavity of bones. In newborns, all bones have active marrow. By the

time a person reaches young adulthood, the bonesof the hands, feet, arms and legs no longer have

functioning marrow. The spine (vertebrae), hip and shoulder bones,

ribs, breastbone and skull contain marrow thatmakes blood cells in adults.


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Blood passes through the marrow and picks

up formed red and white cells, and platelets,

for circulation.


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The process of blood cell formation is called

hematopoiesis.

A small group of cells, the stem cells, develops

into all the blood cells in the marrow by the

process ofdifferentiation


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Stem Cell

Figure 2. Hematopoeisis. Stem cells give rise to the cell lines that produce the formed elements


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In summary, blood cells are made in the marrow.When the cells are formed and functional, theyleave the Marrow and enter the blood. The red

cells and the platelets carry out their respectivefunctions of delivering oxygen and plugging upinjured blood vessels throughout the body. Thewhite cells (neutrophils, eosinophils, basophils,

monocytes and lymphocytes) enter the tissuesto combat infections and perform other immunefunctions.


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ALL: PATHOPHYSIOLOGY

RISK FACTORS12 years old, Male, Family History


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ETIOLOGYunknown

Mutation in the DNA of lymphoid stem cell


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Decreased production of normal blood cells

Decreased PLATELET Decreased RBCs Decreased WBCs

Gingival bleeding

Hematoma

Bruises

Epistaxis

Anemia

Pallor

Fever

RISK FACTORS12 years old, Male, Family History


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ETIOLOGYunknown

Mutation in the DNA of lymphoid stem cell

Lymphoblasts remain immature and persist indefinitely

Uncontrolled proliferation of lymphoblasts in the bone marrow

Lymphoblasts replace the normal marrow elements

Decreased production of normal blood cells

Organ infiltration


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WARD COURSE

Medical Management

Nursing Management


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MEDICAL MANAGEMENT

DAY 1 23 November 2010


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MEDICAL MANAGEMENT

DAY 1

November 23, 2010

Dr. Castillo, Attending Physician, ordered

patient C for various Laboratory

Examinations: CBC, Blood Typing, PeripheralBlood Smear, SGPT, PT, PTT and Urinalysis; and

to start Intravenous Fluid of D5NSS

incorporated with BNC after negative skin test.


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MEDICAL MANAGEMENT

DAY 1

November 23, 2010

Laboratory results were relayed to Dr. Castillo

and he ordered for referral to Dra. Salvador, a

Hematologist, for hemo consultation andmanagement.


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MEDICAL MANAGEMENT

DAY 1

November 23, 2010

8:00 pm, patient was seen and examined by

Dra. Salvador reviewing patients history and

physical examination with impression of AcuteLeukemia, probably Lymphoblastic. Dra.

Salvador planned to perform Bone Marrow

Aspiration and for Flow Cytometry LeukemiaPanel.


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MEDICAL MANAGEMENT



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MEDICAL MANAGEMENT

DAY 2

November 24, 2010

11: 00 am, Bone Marrow Aspiration was doneat iliac crest by Dra. Salvador. Punctured site

pressed for 1-2 hours. Result revealedconsistent with Acute LymphoblasticLeukemia. Medication was started as ordered:Cotrimoxazole 400mg/80cap 1 capsule 2x a

day; Vitamin B Complex 5ml 2x a day;Prednisone 20mg/tab 3x a day after meal;Ranitidine 18mg IV every 8 hours.


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MEDICAL MANAGEMENT

DAY 2

November 24, 2010

Dra. Salvador also planned patient for possible

IT Chemotherapy if platelet count is greater

than or equal to 50, 000.

For repeat CBC 6 hours post blood transfusion.


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MEDICAL MANAGEMENT

DAY 2

November 24, 2010

Patients IVF of D5NSS was shifted to PNSS500ml x KVO as ordered for Blood Transfusion.

Dipenhydramine 18 mg IV was given 30minutes prior to Blood transfusion as ordered.

10:30 pm, patient received initial transfusion

of 2 units of Platelet concentrate and CBC wasrepeated after 6 hours post BT as ordered.

IVF of D5NSS was ordered after BloodTransfusion.


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MEDICAL MANAGEMENT

DAY 3

November 25, 2010

8:00 am, Emla Cream applied on back at L3and 1 inch above and below, then tegaderm

was applied as preparation for ITChemotherapy.

11:00 am, CSF specimen was sent toLaboratory for CSF cell count and differential

count.IT Chemotherapy was done by Dra.Salvador assisted by Nurse-On-Duty.


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MEDICAL MANAGEMENT

DAY 3

November 25, 2010

4:00 pm, 2 units of Platelet Concentrate (3rd

and 4th) were transfused and CBC was repeated

after 6 hours post BT as ordered.

8:45pm, Chemotherapy was started by Dra.

Quiatchon (ACOD), as per order of Dra.

Salvador, via Slow IV Push assisted by Nurse-On-Duty with the following chemodrugs:

Vincristine 1mg and Doxorubicin 10mg or 5ml.


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MEDICAL MANAGEMENT


C G


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MEDICAL MANAGEMENT

DAY 3

November 25, 2010

Dra. Salvador made orders. Patient for

discharge tomorrow with home medication

given: Cotrimoxazole, Vitamin B Complex andPrednisone as ordered.

MEDICAL MANAGEMENT


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MEDICAL MANAGEMENT

DAY 4

November 26, 2010

6:45 am, patient suddenly experienced

epistaxis on both nostrils.

Patient was given Hemostan 250mg 1 cap as

telephone ordered by Dra. Salavdor and

included in home mediction.

9:00 am, 2 units of Platelet Concentrate (5th

and 6th) were transfused as ordered.

MEDICAL MANAGEMENT


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MEDICAL MANAGEMENT

DAY 4

November 26, 2010

11:00 am, patient complained of epistaxis.

Hemostan was given as ordered by Dra.

Quiatchon, ACOD May Go Home order was deferred and repeat

CBC now was ordered by ACOD due toepisodes of epistaxis.

8:30 pm, 2 units of Platelet Concentrate (7thand 8th) were transfused as ordered.


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MEDICAL MANAGEMENT


MEDICAL MANAGEMENT


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MEDICAL MANAGEMENT

DAY 5- November 27, 2010

No episodes of bleeding. Hematoma and

bruises were less evident. Patient was

discharged with improved condition.

To come back on November 29, 2010 for

Blood Transfusion.


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NURSING MANAGEMENT

ACTUAL CARE GIVEN

ACTUAL CARE GIVEN


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ACTUAL CARE GIVEN

Nurses on duty were able to get patienthistory upon admission and throughout

confinement. They were also able to assess

the patient daily and provided necessaryinterventions for each needs and problems

encountered. They collaborated with the

doctors effectively and able to assist on theprocedure done. Routine tasks were also

provided efficiently.


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NURSING CARE PLAN

Infection Protection

Bleeding Precautions

Energy Conservation


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INFECTION PROTECTION

NURSING CARE PLAN



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ASSESSMENT (Cues) Enlarged palpable left cervical lymph node noted

Axillary temperature of 37.3oC

Body weakness noted

Post chemotherapy

Laboratory Studies:

Urinalysis, WBC = 4-8/hpf

CBC, Neutrophils: 24 Peripheral Blood Smear, Blast cells = 10

Presence of immature WBCs and decreasednormal WBCs.



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NURSING DIAGNOSIS

Risk for Infection related to inadequate

secondary defenses: alterations in mature

WBCs.



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PLANNING

After 8 hours of providing necessary

interventions, patient and his family will

identify and demonstrate techniques, lifestylechanges to promote safe environment and to

prevent or reduce risk of infection.



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INTERVENTION

Independent Interventions:

Place in private room. Limit visitors as

indicated. Prohibit use of live plants/cut

flowers. Restrict fresh fruits and vegetables or

make sure they are washed or peeled.

Require good handwashing protocol for allpersonnel and visitors.



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INTERVENTIONIndependent Interventions:

Monitor temperature.

Encourage frequent turning and deepbreathing.

Handle patient gently. Keep linens

dry/wrinkle-free. Inspect skin for tender, erythematous areas;

open wounds.



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INTERVENTION


Inspect oral mucous membrane. Provide good

oral hygiene. Use a soft toothbrush, sponge or

swabs for frequent mouth care.

Coordinate procedures and tests to allow for

uninterrupted rest periods.



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INTERVENTION


Encourage increase intake of foods high in

protein and fluids with adequate fiber.

Avoid/limit invasive procedures as possible.

Provide facial mask.


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INTERVENTION

Collaborative Interventions:

Administer medications as indicated, e.g.

antibiotics.



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EVALUATION

Goal met. Patient and his family identified and

demonstrated techniques to prevent or

reduce risk of infection.


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BLEEDING PRECAUTION

NURSING CARE PLAN

BLEEDING PRECAUTIONS


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ASSESSMENT (Cues) Episodes of epistaxis noted

Pale skin noted with hematoma and bruises

evident on both upper and lower extremities Gingival bleeding noted upon brushing of teeth

Body weakness noted

Laboratory Studies:

CBC, Platelet = 50, 000/cumm

PT = 15.5 seconds

PTT = 44.6 seconds



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NURSING DIAGNOSIS

Risk for injury related to bleeding secondary

to decreased platelet count.



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PLANNING

After 8 hours of nursing interventions,

patients risk for injury and bleeding will be

minimized.



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INTERVENTIONIndependent Interventions:

Inspect skin/mucous membranes for petechiae,

ecchymotic areas; note bleeding gums, frank oroccult blood in stools and urine; oozing frominvasive-line sites.

Implement measures to prevent tissue

injury/bleeding e.g., gentle brushing of teeth orgums with soft toothbrush, cotton swab, orsponge-tipped applicator, avoiding forceful noseblowing when possible.



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INTERVENTION


Provide soft diet.

Restrict activity based on assessment on

platelet count and presence of active

bleeding.

Avoid/limit invasive procedures as possible.



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INTERVENTION


For epistaxis, place patient in high Fowlers

position; apply ice pack to back of neck anddirect pressure to nose.

Notify physician for prolonged bleeding.



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INTERVENTION


Monitor laboratory studies, e.g., platelets,

Hb/Hct, clotting.

Administer Platelets, Clotting factors.

Administer medications as indicated.



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EVALUATION

Goal met. Patients risk for injury and further

bleeding was minimized.


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ENERGY CONSERVATION


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ENERGY CONSERVATION

ASSESSMENT (Cues)

Body weakness

Pale skin noted with hematoma and bruises

on both upper and lower extremities.

On bed rest regimen

Laboratories:

Decreased RBC, Hemoglobin, Hematocrit and

platelets

ENERGY CONSERVATION


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ENERGY CONSERVATION

NURSING DIAGNOSIS

Activity Intolerance related to therapeutic

restrictions (isolation/bed rest)

ENERGY CONSERVATION


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ENERGY CONSERVATION

PLANNING

After 8 hours of nursing interventions, patient

will maintain therapeutic regimen as advised

to conserve energy and participate in ADLs tolevel of ability

ENERGY CONSERVATION


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ENERGY CONSERVATION

INTERVENTION


Evaluate reports of fatigue, noting ability to

participate in activities of ADLs.

Provide quiet environment and uninterrupted

rest periods. Encourage rest periods before

meals.

ENERGY CONSERVATION


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ENERGY CONSERVATION

INTERVENTION


Implement energy-saving techniques, e.g.,

sitting, rather than standing. Assist withambulation/other activities as indicated.

Recommend small, nutritious, high-protein

meals and snacks throughout the day.

ENERGY CONSERVATION


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ENERGY CONSERVATION

INTERVENTION


Provide supplemental oxygen as needed.


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DISCHARGE PLAN

DISCHARGE PLAN


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DISCHARGE PLAN

MEDICATIONS

Encourage mother and patient to comply with

the medication prescribed by the physician.

Cotrimoxazole

Prednisone

Vitamin B Comlpex

Hemostan

DISCHARGE PLAN


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DISCHARGE PLAN

ENVIRONMENT

Encourage mother to provide clean

environment which is free from infectious

agents and to allow patient to rest with aclean surrounding.

TREATMENT

Instruct the mother to follow the physiciansorder for patients treatment.

DISCHARGE PLAN


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DISCHARGE PLAN

HEALTH TEACHING

Discuss health teachings to the mother and

patient and allow them to ask questions for

further information.OUTPATIENT FOLLOW-UP

Encourage frequent resting period and advise

on scheduled follow-up.

DISCHARGE PLAN


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DISCHARGE PLAN

DIET Instruct the mother to follow the patients diet

ordered by the physician.

Diet that includes rich in vitamin C , plantsources that are rich in protein and fiber.

SPIRITUAL

Encourage mother and patient to strengthentheir faith and be able to cope with patientscondition.


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THANK YOU


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LABORATORY STUDIES AND

DIAGNOSTICS

COMPLETE BLOOD COUNT

November 23, 2010


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RESULTS NORMAL VALUES

Hemoglobin 11.2 mg/dl M: 1417 mg/dl

Hematocrit 0.35 % M: 0.420.51 %

Red Blood Cells 4.19 million/cumm 45 million/cumm

Platelet Count 50,000/cumm 150,000450, 000/cumm

White Blood Cells 36, 100/cumm 5,00010,000/cumm

Segmenters 18 5565

Lymphocytes 82 2535

Eosinophils 0 24

Monocytes 0 25

Basophils 0 00.5


November 25, 2010


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Hematocrit 0.33 % M: 0.420.51 %



White Blood CellsCells 49, 100/cumm

5,00010,000/cumm

Segmenters 24 5565

Lymphocytes 75 2535

Eosinophils 01 24

Monocytes 0 25

Basophils 0 00.5


November 26, 2010


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Hematocrit 0.31 % M: 0.420.51 %



White Blood CellsCells

15, 300/cumm 5,00010,000/cumm

Segmenters 38 5565

Lymphocytes 60 2535

Eosinophils 2 24

Monocytes 0 25

Basophils 0 00.5

November 23, 2010


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BLOOD TYPING

Blood Typing Rh

Blood Typing ABO

Positive

Type B

PERIPHERAL BLOOD SMEAR

November 23, 2010


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Red cells are generally HYPOCHROMIC and

MICROCYTIC.White cells are predominantly lymphocytes.

There are no toxic granules.

There are blast cells seen.

Platelets are few.

Segmenters23

Lymphocytes62

Monocytes5

Blast10

Actual Platelet Count50s

REMARKS: Consider Acute Leukemia

Further hema evaluation needed.

November 23, 2010


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SGPT

Result Normal Value

SGPT/ALT 32 (M) < 41 U/L

November 23, 2010


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PT and PTT Blood Test

Prothrombin Time

Partial ThromboplastinTime

RESULT

15 seconds

44.6 seconds

NORMAL

1216 seconds

seconds2439 seconds

secondsA prolonged PTT means that clotting is taking longer to occur than expected and may be

due to a variety of causes. Normal PT and slightly prolonged PTT may indicate decreased

or defective factor VIII, IX, or XI.

URINALYSIS

November 23, 2010


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ColorTransparency

Specific GravitypHAlbuminSugar

WBCRBCBacteriaEpiCells

Mucusthreads

AmorphSedTrichomonasCrystalsCasts

YellowSlightly Cloudy

1.0106.5

NegativeNegative

4

8/hpf0 2 /hpf

FewOccasional

Moderate

ModerateNoneNoneNone

BONE MARROW ASPIRATION


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Bone marrow aspiration removes a smallamount of bone marrow fluid and cells

through a needle put into a bone. The bone

marrow fluid and cells are checked for

problems with any of the blood cells made in

the bone marrow. Cells can be checked for

chromosome problems. Cultures can also be

done to look for infection.

FLOW CYTOMETRY LEUKEMIA PANEL


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Flow cytometry identifies types of leukemia

cells found in samples of blood, based on the

chemicals found on the surface of the

leukemia cell. Flow cytometry uses laser

beams to identify these different chemicals.Flow cytometry is important in classifying

acute lymphocytic leukemia (ALL).

November 25, 2010


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BODY FLUID ANALYSIS

Specimen: CSF

RBC RARE

WBC 5 x 106

Segmenters 0

Lymphocytes 100 %


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DRUG STUDY


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EMLA CREAMTOPICAL ANESTHESIC


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ACTION: numbs the skin and surrounding area

INDICATION: indicated as topical anesthetic forminor procedure

SIDE EFFECTS: paleness, itching, rash

CONTRAINDICATION: contraindicated in patients

with a known history of sensitivity to localanesthetics

NURSING CONSIDERATION: Do not apply near eyes or on open wounds.

Application to larger areas or for longer times thanthose recommended could result in sufficientabsorption of lidocaine and prilocaine resulting inserious adverse effects

COTRIMOXAZOLEANTIBACTERIAL (prohylactic)


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(p y )

ACTION: inhibits bacterial growth by inhibiting

synthesis of dihydrofolic acid.

INDICATION: UTI, URTI, All immunocompromised

patients should be treated with cotrimoxazole to

prevent Pneumocystis carinii

SIDE EFFECT: gastrointestinal upset

CONTRAINDICATION: Documented

hypersensitivity; megaloblastic anemia due to

folate deficiency

COTRIMOXAZOLE NURSING CONSIDERATION:


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Skin test

Tell patient to take drug as prescribed if he feels

better.

Tell patient to report adverse reaction.

Advise patient to avoid prolonged sun exposure. Take drug on an empty stomach.

VITAMIN B COMLEXMULTIVITAMINS


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ACTION:A coenzyme that stimulate metabolic

function and is needed for cell replication,hematopoiesis.

INDICATION: Anemia

SIDE EFFECTS: transient diarrhea


hypersensitivity

PREDNISONECORTICOSTEROID


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ACTION: Decreases inflammation, mainly

stabilizing leukocyte, lysosomal membranes.

Suppresses immune system, stimulate bone

marrow and influences CHO, CHON, fats

INDICATION: Important chemotherapeuticagent in treatment of ALL.

SIDE EFFECTS: hypertension, dyslipidemia,

hyperglycemia

PREDNISONE CONTRAINDICATION: Documented


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hypersensitivity; serious infections (excluding

meningitis and septic shock) and fungal

infections; varicella infections

NURSING CONSIDERATION:

Avoid exposure to infection.

Do not stop taking the drug without consultin

health care provider

RANITIDINEH2 - BLOCKER


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ACTION: reduce stomach acid production

INDICATION: to prevent gastric ulcer

SIDE EFFECTS: nausea, dizziness, constipation

CONTRAINDICATION: hypersensitivity to the

drug


Report sore throat, fever, unusual bruising or

bleeding, tarry stools, confusion, hallucinations,

dizziness, severe headache, muscle or joint pain.

DIPENHYDRAMINEANTIHISTAMINE


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ACTION: prevents types of transfusion

reaction

INDICATION: allergic reaction, prophylaxis

prior to BT

SIDE EFFECTS: sedation, tiredness, sleepiness,

dizziness

CONTRAINDICATION: hypersensitivity

VINCRISTINE SULFATEANTINEOPLASTIC (Chemotherapy Drug)


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( py g)

ACTION: interferes with the growth of thecancer cells and slows their growth andspread in the body.

INDICATION: Acute Leukemia and other

neoplastic conditions SIDE EFFECTS: nausea and vomiting,

headache, mouth sores, dizziness, temporaryhair loss

CONTRAINDICATIONS:Patients with thedemyelinating form of Charcot-Marie-Toothsyndrome


VINCRISTINE SULFATE


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Fatal if given intrathecally. Properly position the intravenous needle/catheter

before administering medication.

Burning precaution.

Tell health care professional immediately if

experience pain, irritation, redness, or swelling at

the injection site.

Must be given slowly into vein only.

DOXORUBICINANTINEOPLASTIC(Chemotherapy Drug)


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ACTION: interferes with the growth of the

cancer cells and slows their growth and

spread in the body.

INDICATION: Acute Leukemia and other

neoplastic condition

SIDE EFFECTS: Nausea, vomiting, diarrhea, loss

of appetite,

CONTRAINDiCATION: baseline neutrophil

count


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Must be given slowly into vein only. Notify doctor immediately if redness, blistering,

sores, pain, or swelling occur at/near the injection

site.

HEMOSTAN


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Antihemorrhagic/antithrombolytic


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INTRATHECAL CHEMOTHERAPY

INTRATHECAL CHEMOTHERAPY


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Cancer cells can pass into the cerebrospinalfluid, which surrounds the brain and spinalcord to protect and cushion it. Chemotherapygiven by any other route cannot cross over

into the cerebrospinal fluid. Therefore thebest way to remove these cells is to givechemotherapy directly into the cerebrospinal

fluid. The procedure to give intrathecalchemotherapy is called a lumbar puncture(LP).


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Documents

CASE PRE- Acute Lymphoblastic Leukemia