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Luekemia ppt

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MS.C.MARY LALITHA KALA
ASSISTANT PROFESSOR, MEDICAL AND SURGICAL NURSING
ANRI COLLEGE OF NURSING
VISAKHAPATNAM

Published in: Health & Medicine
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Luekemia ppt

  1. 1. MS.C.MARY LALITHA KALA LECTURER, MEDICAL AND SURGICAL NURSING G.S.L COLLEGE OF NURSING RAJAHMUNDRY
  2. 2. DEVELOPMENT OF NORMAL BLOOD CELLS
  3. 3. FUNCTION OF WBC 1.NUETROPHILS: INFLAMMATORY REACTION WITHIN 1 HOUR 2.MONOCYTES: SEOND LINE OF DEFENSE. 3.MACROPHAGES: EFFECTIVE AGAINST FUNGAL AND VIRAL AGENTS. 4.EOSINOPHILS AND BASOPHILS: HYPERSENSITIVITY REACTIONS. 5.LYMPHOCYTES: HUMORAL AND CELLULAR IMMUNITY.
  4. 4. DEFINITION “IT IS AN UNCONTROLLED PROLIFERATION OF WHITE BLOOD CELLS MOSTLY INVOLVING THE DEVELOPMENT OF IMMATURE , DYSFUNCTIONAL WBC”.
  5. 5. TYPES OF LEUKEMIA LUEKEMIA MYELOID LYMPHOID ACUTE CHRONIC ACUTE CHRONIC
  6. 6. LEUKEMIAS
  7. 7. 1.ACUTE MYELOID LEUKEMIA RESULTS FROM THE DIFFERENTIATION OF THE STEM CELL INTO ALL MYELOID CELLS INCIDENCE:  ALL AGE GROUPS.  PEAK AT 60 YEARS.
  8. 8. CLINICAL MANIFESTATIONS NUETROPENIA ANEMIA THROMBOCYTOPENIA PROLIFERATION OF LEUKEMIC CELLS IN ORGANS HYPERPLASIA OF GUMS BONE PAIN
  9. 9. ASSESSMENT AND DIAGNOSTIC FINDINGS 1. COMPLETE BLOOD COUNT. DECREASED ERYTHROCYTE AND PLATELET COUNT 2. BONE MARROW ANALYSIS.
  10. 10. COMPLICATIONS BLEEDING INFECTION ECCHYMOSIS PETECHAEI
  11. 11. MEDICAL MANAGEMENT 1 INDUCTION: CYTARABINE DAUNORUBUCIN MITOXANTRONE IDARUBUCIN. 2 CONSOLIDATION THERAPY BONE MARROW TRANSPLANTATION PERIPHERAL BLOOD STEM CELL TRANSPLANTATION
  12. 12. 2.CHRONIC MYELOID LUEKEMIA • ARISE DUE TO A MUTATION IN MYELOID STEM CELL RESULTING IN THE FORMATION OF PREMATURE OR IMMATURE FORMS. • MUTATION: BRC gene 22 + ABL gene 9 ORAL TYROSINE KINASE PROTEIN IS FORMED RAPID DIVISION OF WBC
  13. 13. CLINICAL MANIFESTATIONS MOSTLY ASYMPTOMATIC WBC > 100,000/mm3 _shortness of breath _slightly confused _enlarged tender spleen _malaise, anorexia, weight loss.
  14. 14. STAGES OF CML 3 STAGES ARE PRESENT:  CHRONIC  TRANSFORMATION  ACCELERATED STAGE/BLAST CRISIS.
  15. 15. MEDICAL MANAGEMENT ORAL TYROSINE KINASE INHIBITORS CONVENTIONAL THERAPY: _INTEREFON ALPHA _CYTOSINE LESS AGGRESSIVE THERAPY _HYDROXY UREA _BUSALFAN
  16. 16. 3.ACUTE LYMPHOCYTIC LEUKEMIA RESULTS FROM AN UNCONTROLLED PROLIFERATION OF IMMATURE CELLS (LYMPHOBLAST)DERIVED FROM LYMPHOID STEM CELL B Lymphocyte-75% T Lymphocyte_25% INCIDENCE:  COMMON IN YOUNG CHILDREN  PEAK INCIDENCE IN 4 YEARS
  17. 17. PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS IMMATURE LYMPHOCYTES PROLIFERATE IN THE BONE MARROW CROWD THE DEVELOPMENT OF NORMAL MYELOID CELLS INHIBITION OF NORMAL HEMATOPOEISIS RESULTS IN REDUCED NUMBER OF luekocytes erythrocytes platelets
  18. 18. MEDICAL MANAGEMENT  INDUCTION THERAPY: 1. INTRA THECAL CHEMOTHERAPY _METHOTREXATE. 2. CORTICOSTEROIDS.  MAINTAINANCE PHASE: CHEMOTHERAPUETIC AGENTS FOR 3 YEARS.
  19. 19. 4 CHRONIC LYMPHOCYTIC LEUKEMIA COMMON MALIGNANCY OF OLDER ADULTS INCIDENCE MORE IN PEOPLE OLDER THAN 60 YEARS OF AGE
  20. 20. PATHOPHYSIOLOGY A MALIGNANT CLONE OF B LYMPHOCYTE (T LYMPHOCYTE IS RARE) FEATURES MATURE WBC WITH ANTIGEN CD 52 ESCAPES APOPTOSIS EXCESSIVE ACCUMALATION OF THE CELLS IN THE MARROW AND CIRCULATION LYMPHOCYTE COUNT >100,000mm3 ( diagnostic evaluation)
  21. 21. CLINICAL MANIFESTATION LYMPHADENOPATHY HEPATOMEGALY SPLEENOMEGALY CONSTELLATION OF SYMPTOMS  _FEVER  _DRENCHING SWEATING  _UNINTENSIONAL WEIGHTLOSS  DEFECT IN CELL MEDIATED AND HUMORAL MEDIATED IMMUNITY  ANERGY
  22. 22. MEDICAL MANAGEMENT REQUIRES NO TREATMENT IF SYMPTOMS SEVERE  _CHEMOTHERAPY CORTICOSTEROID CHLORAMBUCIL CYCLOPHOSPHAMIDE VINCRISTIN DOXORUBUCIN
  23. 23. NURSING MANAGEMENT
  24. 24. NURSING DIAGNOSIS 1. RISK FOR INFECTION AND BLEEDING 2. RISK FOR IMPAIRED SKIN INTEGRITY IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS 3. FATIGUE AND ACTIVITY INTOLERANCE 4. RISK FOR DEFICIT FLUID VOLUME 5. ANXIETY DUE TO KNOELEDGE DEFICIT
  25. 25. NURSING INTERVENTIONS
  26. 26. 1. PREVENTING /MANAGING INFECTION AND BLEEDING 1. HAND WASHING 2. PREVENT INJURIES /FALLS 3. MAINTAIN STERILE AND ASEPTIC TECHNIQUES
  27. 27. 2. IMPROVING NUTRITIONAL INTAKE 1. MOUTHCARE BEFORE AND AFTER MEALS 2. SMALL FREQUENT FOODS WHICH ARE SOFT IN TEXTURE MODERATE IN TEMPERATURE
  28. 28. 3. EASING PAIN AND DISCOMFORT 1. ACETAMINOPHEN 2. GENTLE BACK AND SHOULDER MASSAGE 3. FREQUENT CHANGING OF BED CLOTHES
  29. 29. 4.MAINTAINING FLUID AND ELECTROLYTE BALANCE 1. INTAKE AND OUTPUT TO BE MEASURED ACCURATELY 2. REPLACEMENT OF ELECTROLYTES PARTICULARLYPOTASSIUM AND MAGNESIUM
  30. 30. 5. TEACHING SELF CARE 1. SELF IDENTIFICATION OF SIGNS AND SYMPTOMS 2. FOLLOWING THE MEDICATION REGIMEN ACCURATELY 3. FOLLOWING ADEQUTE HYGIENIC MEASURES AT HOME.
  31. 31. QUESTIONS TIME ?
  32. 32. 1. WHICH CELL IS INVOLVED IN LEUKEMIA? 2. WHAT IS THE CELL WHICH GIVES RISE TO ALL THE CELLS? 3. WHAT IS LEUKEMIA ? 4. WHAT IS ACUTE MYELOID LEUKEMIA 5. WHAT MUTATION OCCURS IN CHRONIC MYELOID LEUKEMIA?
  33. 33. 6. WHAT ARE THE STAGES OF CML? 7. WHICH CELL IS INVOLVED MORE IN ALL? 8. WHAT IS THE MEDICAL Rx FORALL? 9. WBC ESCAPE APOPTOSIS IN WHICH TYPE OF LEUKEMIA? 10. NURSING MANAGEMENT FOR A LEUKEMIC CLIENT?
  34. 34. ANSWERS 1. WBC. 2. MULTIPOTENT STEM CELL. 3. IT IS AN UNCONTROLLED PROLIFERATION OF WHITE BLOOD CELLS MOSTLY INVOLVING THE DEVELOPMENT OF IMMATURE , DYSFUNCTIONAL WBC. 4. RESULTS FROM THE DIFFERENTIATION OF THE STEM CELL INTO ALL MYELOID CELLS
  35. 35. 5. MUTATION: BRC gene 22 + ABL gene 9 ORAL TYROSINE KINASE PROTEIN IS FORMED RAPID DIVISION OF WBC
  36. 36. 6. THREE STAGES ARE PRESENT:  CHRONIC, TRANSFORMATION, ACCELERATED STAGE/BLAST CRISIS. 7. B LYMPHOCYTE. 8. INDUCTION THERAPY: 1. INTRA THECAL CHEMOTHERAPY _METHOTREXATE. 2. CORTICOSTEROIDS. MAINTAINANCE PHASE: CHEMOTHERAPUETIC AGENTS FOR 3 YEARS.
  37. 37. 9. CLL 10.  PREVENTING/ MANAGING BLEEDING AND INFECTION. IMPROVING NUTRITIONAL INTAKE EASING PAIN AND DISCOMFORT MAINTAINING FLUID AND ELECTROLYTE IMBALANCE TEACHING SELF CARE

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