Nursing 211

N211: Health Differences Across the Lifespan I

Nursing Interventions Include monitoring surgical site for hemorrhage and infection; use temperature as the most accurate indicator of infection. Monitor skin integrity at radiation site. Monitor mucus membrane integrity minimize exposure to infection and monitor bleeding. 3.24 Leukemia Leukemia is a malignancy of blood forming tissues of the bone marrow, spleen and lymph system characterized by unregulated proliferation of WBCs. Type of leukemia is classified by type of WBC affected (granulocytes, lymphocytes, monocyte). Acute lymphocytic leukemia (ALL): peak incidence at 2-4 years of age; immature granulocytes proliferate and accumulate in the bone marrow. This is the most common childhood cancer. The prognosis is favorable, 80% of children treated lived 5 years or longer. Acute myelogenous leukemia (AML) involves the inability of leukocytes to mature; those that do are not normal. It can occur at any time during the life cycle. Onset is insidious. Prognosis is poor; cause of death tends to be overwhelming infection. Chronic myelogenous leukemia (CML) results from abnormal production of granulocytic cells. The chronic stage lasts approximately 3 years and the acute phase lasts 2-3 months. It occurs in young to middle aged adults. Prognosis is poor. Treatment is conservative with Hydroxyurea (Hydrea), Interferon and Imatinib mesylate (Gleevec). Chronic lymphocytic leukemia (CLL) involves the increased production of leukocytes and lymphocytes and the proliferation of cells within the bone marrow, spleen and liver. It occurs after the age of 35, often in older adults. Most clients are asymptomatic and are not treated. Nursing Assessment includes for ALL and AML tendency for client to bleed, nosebleeds, petecchiae, bleeding gums, ecchymosis, non-healing skin abrasions, fatigue, pallor, headache, bone pain, hepatosplenomegaly. With CML client will complain of night sweats and splenomegaly. Clients with CLL will have early on frequent skin and respiratory infections. Late symptoms are lymphadenopathy and splenomegaly, bleeding and bruising, skin lesions and bone tenderness. Nursing Diagnosis • Anxiety and knowledge deficit of patient or parents and child related to diagnosis of cancer and treatment • Risk for infection related to myelosuppression from chemotherapy/bone marrow transplant • Pain related to diagnostic procedures and progression of disease


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