N211: Health Differences Across the Lifespan I • Activity intolerance related to fatigue secondary to the effects of chemotherapy/bone marrow transplant • Potential for injury related to altered coagulation • Altered nutrition: less than body requirements related to effects of the disease process and treatment. Diagnostics Include increased WBC (in CLL and CML), a normal, decreased or increased WBC (in ALL and AML); decreased reaction to skin sensitivity tests; bone marrow tests reveal excessive blast cells in AML; Philadelphia chromosome found in 90-95% of clients with CML; BCR/ABL gene is present in virtually all clients with CML. Bone marrow biopsy and aspiration is the definitive diagnostic test. Medical Interventions Include high dose chemotherapy, radiation therapy, autologous or allogenic bone marrow transplant, stem cell transplant, palliative care and symptoms management. • Alkylating agents are Busulfan and Myleran. • Anthracyclines are Doxorubicin, Adriamycin. • Antimetabolites are Fludarabine and Fludara. • Corticosteroids are Prednisone. • Plant Alkaloids are Vincristine and Oncovin. AML: Daunorubicin, cytarabinem doxorubicin, idarubicin, 6-thioguanine, mitoxantrone, combination chemotherapy or antitumor antibiotic and cystosine arabinoside or antitumor antibiotic and cystosine arabinoside and thioguanine. ALL: daunorubicin, doxorubicin, vincristine, prednisone, 1-asparaginase, cyclophosphamide, methotrexate, 6-mercaptopurine, cytarabine, combination chemotherapy of cyclophosphamide and vincristine and prednisone and antitumor antibiotic and 1-asparaginase, combination chemotherapy of daunorubicin and cytarabine and 6-mercaptopurine and vincristine and prednisone. CML: Busulfan (Myleran), hydorxyurea (Hydrea), combination therapy including any of the following: cytarabine, thioguanine, daunorubicin, methotrexate, prednisone, vincristine, 1-asparaginase, carmustine, 6-mercaptopurine. CLL: Chlorambucil (Leukeran), cyclophosphamide (Cytoxan), prednisone, cyclophosphamide, vincristine and prednisone, Fludarabine. Nursing Interventions Include maintaining neutropenic and bleeding precautions; provide diversionary activities; maintain good nutrition; provide emotional support to client and family. Administer prescribed drugs and monitor for side effects. Prepare client for bone marrow transplantation.
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