Sunday, November 24, 2019
Leukemia Case Study Essays
Leukemia Case Study Essays Leukemia Case Study Essay Leukemia Case Study Essay Leukemia are cancers of the blood- forming tissues. White blood cells may be produced in excessive amounts and are unable to work properly which weakens the immune system. The patient is a 68 year old male admitted on 02/07/201 S with chief complaint of weakness and shortness of breath. Patient was admitted to the medical- surgical unit with pneumonia. Description of Condition First of all, What is Leukemia? In healthy person, white blood cells are produced in the bone marrow and then it transfer to the blood in a continuous basis. Bone marrow is the spoon). Tissue inside the bone where blood cells are made. They are produced by stem cells in the long bones. According to Assignations and Workman (201 3), Leukemia accounts for 2% of all new cases of cancers and 4 % of all deaths from cancer (as cited in American Cancer Society, 2011). In a person with ML the same process occurs, except the white blood cells production proceeds to an excessive uncontrollable rate of immature white bloo d cells. In acute leukemia, the leukemia or blast cells function abnormally and accumulate in the peripheral blood, the bone marrow, and central nervous system. At an uncontrollable rate leukemia cells dont stop diving when should. Most patients with acute leukemia will only live few months if left untreated. Body then is deprived of essential components for its immune system. Leukocytes(white blood cells) protect our bodies from infections and cancer development. Furthermore, it presents with pare skin, patchier, bleeding from minor cuts, lack of energy , and mild fever and aches in the joints or bones(Leukemia and Lymphoma Society, 2011). There are may types of leukemia, but the four most common forms are derived from only two types of cells, lymphocytes, and employees. There are subtypes of these diseases, which are classified depending on pacific cell type involved or degree of maturity. The estimates for leukemia in the United States for 2014 are about 1 8,860 new cases of Acute Myeloid Leukemia. Most will be in adults. (American Cancer Society, 2014). Etiology and Risk factors The exact cause of leukemia is unknown. There are many different origins and risk factors for the four main kinds of leukemia and while some may be directly linked, there are others that show small linkage to anything at all. Environmental and genetic factor are involved in the development of leukemia. Risk factors to the development of leukemia include environmental actors, immunologic factors, genetic factors, reduced production of blood cells in the bone marrow, exposure to chemical and drugs, viral infections, and ionizing radiation. ML has no main risk factors, but does have a few potential risk factors like excessive exposure to benzene, a chemical found in cigarette smoke and work places (Leukemia and Lymphoma Society, 2011). Smoking is a risk factor for many diseases such as lung cancer, heart disease, kidney disease among others but what most people fail to realize, It is a risk factor for leukemia. Leukemia can be acute, with sudden onset and short oration, or chronic, with slow onset and persistent symptoms for years. According to Assignations and Workman (201 3), With Leukemia, cancer most Often Occurs in the Stem cells or early precursor leukocyte cells, causing excessive growth or a specific type of immature leukocyte (p. 880). Also, the cells accumulate in the blood and in certain organs, forcing out healthy cells and interfering with the function offbeat organ. ML is caused by abnormalities of our DNA that controls the development in your bone marrow. These abnormal cells build up and replace healthy cells. Sign and Symptoms The patient with acute leukemia has abnormal labs like decrease hemoglobin and homoerotic levels, low platelet count and abnormal white blood cells counts. There are some changes associated with acute leukemia due to these abnormal labs. The blood circulate through the body thus affecting all organ systems. There are may symptoms of ML, in the early stages, the symptoms of ML may resemble the flu. Symptoms of leukemia are linked with the blood function because the initial pathogenesis of the disease in on the bone marrow . The following are the common manifestations of leukemia : anemia , bleeding or bruising bone and joint ins , recurrent infections due to an increase in immature white blood cells, swollen lymph nodes abdominal distress , and breathing difficulty. Anemia due to a low ROB count. Because red blood cells carry oxygen throughout the body . The anemia occurs due to the incapacity of the bone marrow to produce red blood cells in association with the overcrowding Of the bone marrow with the proliferating cancerous cells . Manifestations of this symptom include the tiredness of the patient, faster breathing , and paleness, fatigue and short of breath. Patient is unable to do simple this like bathing because there is no energy. Also, skin becomes pale and cool to touch as a result of reduced tissue perfusion. Leukemia which is a low WEB count or decrease in production of mature, healthy, functional white blood cells. Leukocytes, which in turn weaken the body immune response; thus, the patient is vulnerable and prone to recurrent infections. Recurrent infections that can be viral or bacterial and occurs over the past weeks are brought about by the disrupted capacity of the immune system to mount an immune response due to the presence of immature white blood cells . Thermodynamic a low blood platelet count. The platelets are the load cells responsible for blood clotting. A shortage of blood platelets may lead to easy bruising or bleeding. The multitudes of cells present in the bone marrow results to pain in joint and bone . Abdominal distress is an outcome of the pooling of leukemia cells in the liver spleen , and kidney which causes the swelling of these organs. Because of enlarged liver or spleen or surrounding organs due to the build up Of abnormal cells spleen and liver may cause feeling of fullness (loss of appetite). This leads to weight loss, anorexia, nausea. Blood clotting times and factors are abnormal. Clotting time is prolonged as well. Patient History and Medication Reconciliation Patient is a 68 year old male. He was admitted on 02/07/2015 with chief complaint of weakness and shortness of breath. Patient has a past history of coronary artery disease status post MI, trial fibrillation status post pacemaker, leukemia, in remission, Hyperglycemia, Hypertension, anomic brain injuries after cardiac arrest, who has been complaining of weakness over the last 2 weeks. The patients family were concerned for pneumonia and they call EMUS. He was found to have pneumonia by chest x-ray in the Emergency Room. Patient diagnostic test in the ERE include White blood cell 3. , Hemoglobin 11 . 1, platelets 90, sodium 129, potassium 4, chloride 92, vicars 27, BUN 19, creating 0. 2, glucose 137, EKE is sinus rhythm at 72 beats per minute, wide SIRS, nonspecific inter ventricular block, SST-T abnormality, dioxin 0. 7, trooping less than 0. 01, BAN 5081. The patient past us racial history include CAB, material valve replacement with mechanical valve, Hernia repair, pacemaker in place. Patient is allergic to codeine. Patient had itch skin as stated by wife. Patient has a history of smoking long time ago. Smoked 1 pack daily for 20 years. The patient uses alcohol rarely. Patient lives at home with his wife. Patient home medication include Emendation 200 MGM once daily, transportation 20 MGM once daily, dioxin O. 25 MGM once daily, hydrazine 25 MGM ;ice dally, shorebird 20 MGM twice daily, lowercase 1 MGM Q. H. S PR. , meteorology MGM once daily, proton 40 MGM once daily, superannuation 25 MGM once daily, soma 0. 4 MGM once daily, Commanding 1 MGM once daily. Patient was admitted to the medical-surgical floor with pneumonia patient will be put on elevating and given ethylene as needed for fever. Patient is positive for dizziness, positive for shot-term memory loss, positive for dry cough, positive for shortness of breath. No chest pain, no nausea or vomiting. No abdominal pain, no diarrhea, no constipation Positive for fever. Nursing Assessment, Medications, and Labs Patient noted to be sleeping on arrival. Patient breathing normally with occasional cough. Patient recent Vitals (0)38. 2-76-18 on 2. 5 L 1 19/54. Patient had no pain at this time. Patient is on fall precautions. Patient noted to be confused and respond to voice only. Patient physical exam reveals him to be alert and oriented to person, place, and time. He communicates, though not readily. His speech and vision are intact but only to voice. Patient spends to voice commands only, and when looking at him in the eye. He has an equal grip bilaterally and can move all extremities, though he is slightly weak and needs assistance with nursing activities such as with reposition. Patient is on telemetry monitor. His apical pulse 78. Capillary refill is less than 2 s. No Jugular vein distention noted. His peripheral pulses are weak and equal. No B/L peripheral edema noted. Patient had flowstone in place. No shortness of breath noted. No nasal flaring. Chest expansion symmetrical. His left lung is clear on auscultation, but right upper lobe of the Eng rancho was heard on auscultation, his respiratory rate is 18, and his oxygen saturation is 98% on 2. L of oxygen via nasal canal. Patient is able to turn, cough and deep breath. Patients wife assisted him with the use of incentive speedometer at 1200. Patient noted to have a pacemaker on right chest wall. Also, on the left chest patient has an infusorians that hasnt been access. In the middle of the chest patient has an old scar form CAB. He has positive bo wel sounds in all quadrants on auscultation , and his abdomen is soft, round, and non tender. He had a small loose brownish bowel moment this morning. Patient is passing flatus. He is on a regular diet, but his appetite has been poor for the past few weeks his wife stated. Wife stated that patient did not have anything to eat for breakfast except for a few sips of juice. For lunch, wife fed patient about 25% and 120 ml of milk. Patient takes pills whole. Patient has his own teeth, and does not wear glasses. No bladder distention noted. No burning on urination. Client is incontinent of urine. This morning nursing student put a new condom catheter. Client is voiding appropriately and his urine is clear and yellow. No foul odor or cloudy. He appears pale and is unkempt. His skin is warm, dry, and intact. NO ash noted. Oral cavity dry. He appears somber and is slow to comply with nursing instructions. Patient has a saline lock on left arm on the thumb side. No pain, rather, edema noted. At 1 100, 0. 9% INS IV fluids 50 ran_/hrs. Patient is on bed rest. He is out of bed with assistance of 2. And transfer with assistance of 2. He needs assistance to set up meal tray. Patient was wash this morning, though he was tired. He was turn at 1200, 1400. Patient ID band was in place. Call bell in reach. Patient demonstrated ability to push button on call bell. Partial side rails up, fall risk identified, fall alert sigh in place. Patient is a DON/DIN. When talking with wife, she stated that she is the primary caregiver at home. Her husband sleep in a regular bed. Case manager was in this morning discussing with the wife of the patient about possible discharge to a nursing home. Patient current medication list include for angina therapy, Shorebird Monetarist to be given 20 MGM orally 2 times per day, Mentality agents; Lowercase 1 MGM orally every day at bed time, Antichrists; moderation administer consistently in regards to food/meals 200 MGM orally everyday. Anticoagulants; warring 2 MGM orally every day, patient currently not on medication. Interdisciplinary; transition 20 MGM orally every day. Interventions therapy engage; hydrazine 25 MGM orally 2 times per day. Beta adrenaline blocker; meteorology ERE 150 MGM orally every day. Cardiac Interlopes; Dioxin 127 meg orally every day. Diuretics; superannuation 17. 5 orally every day. Peptic ulcer therapy; proton 40 MGM orally every morning. Prismatic Hypertrophy agent; Tomlinson ERE 0. 4 MGM orally everyday. Patient is on Sodium Chloride 0. 9 IV 50 ml/hrs continuous. Levitation in DEW MGM IV every 24 hrs. Opprobrium-alabaster 0. OMG-3 MGM inhalation every 6 hrs. Bonaparte 200 MGM orally three times a day as needed for cough. Suffering 600 MGM oral every 12 hours to reduce viscosity of secretions. Chlorinating 25 MGM orally. Patient lab include: on 02/07/15 CB with Dif include Interruption 14. 6, Lymphocyte 21. 0, Monocots 64. 1, Censorship 0. 2. On 02/10/15, WEB count 1. 9, Hemoglobin 9. 6, Homoerotic 28. 9, Platelets 62, BUN 34, creature 0. 70, sodium 133, potassium 4. 3, Albumin 2. 8, promote 35. 5. On 02/12/15, WEB count was 0. 8, ROB count 2. 75, Hemoglobin 9. 0, Homoerotic 26. 8, Platelets 42, Interruption 4. 9, Lymphocytes 85. , Monocots 9. 7, Promote 35. 5, INNER 3. 23. On 2/9/15 patient had an cardiograms which show iterate left ventricular dilation, Hyperkinetic inferior wall. Severely reduced FEE estimated at 20-30%. Normally function mechanical valve. Diagnostic procedure and Treatment Diagnosing acute myeloid leukemia (ML) and ML subtype usually involves a series of tests including complete blood count and bone marrow aspiration and biopsy (Leukemia and Lymphoma Society, 201 1). The gold standard for diagnosing leukemia is an examination of cells obtained from bone marrow aspiration and biopsy. The bone marrow full immature cells. This cells have tags( antigen) on the surface of cell. The specific antigens can alp diagnose the type of leukemia. Due to accelerated research and advances in oncology medicine in recent years, there are several forms of treatment available for the patient with leukemia. The main types of treatment selected for most patients with leukemia today are chemotherapy, radiation, and stem cell transplantation also know as homeopathic stem cell transplantation(HOST) (Assignations Workman, 201 3, p. 883-889). The type of treatment selected by the patient and doctor is based on many factors including the type of leukemia, the age of the patient, and other health issues or problems the patient may have. There are a few efferent treatments recommended for ML depending on the severity and the individual patient. A combination of chemotherapy drugs is the most popular initial treatment. Antibiotics may also be recommended to prevent infection which is very common in this disease. Drug therapy for patient with ML is divided in three distinctive phases: Induction, consolidation, and maintenance (Assignations Workman, 2013, p. 83) Chemotherapy is the use of anticancer drugs design to slow or stop the growth of rapidly diving immature cells in the body. While chemotherapy targets cancer cells, it can also damage health cells and cause unpleasant side effects. ML treatment is generally done in two phases: induction therapy, consolidation therapy; thus,Len induction chemotherapy a combination of dr ug is used to destroy as many leukemia cells as possible and bring blood counts to normal (Leukemia and Lymphoma Society, 201 1). At this phase of treatment patient emotional, physical, social state are vulnerable. The anticancer drugs take a toll on the body, making the patient more at risk for infection. Nausea, vomiting, diarrhea, loss of hair, mouth sores, are among the many undesirable side effects patient experience while going through this phase. Prolonged hospitalizing are common while the patient is entropic (Assignations Workman, 2013, p. 884). Then, consolidation chemotherapy is used to destroy any remaining leukemia cells that cannot be seen in the blood or bone marrow. It consist of another course of either the same drugs use for induction at a different dosage or a different combination of chemotherapy drugs; HOST also may be considered, depending on the disease subtype and the patients response to induction therapy (Assignations Workman, 2013, p. 884). Not only do the body immune system is weak by the mass production f immature WEB, but chemotherapy severely suppresses the bone marrow leaving patient at an increase risk for infection. Nursing care for this patient is vital. Nurses caring for the patient with leukemia face many challenges. It is crucial that should not only understand the disease process, but treatment course as well. This enables them to educate their patient, administer treatment safely, and manage for possible side effects; but also to provide support to the patient and family. HOST is the standard treatment for the patient with leukemia who has a closely matched donor and who is in temporary remission after induction These treatments are lethal to the bone marrow, and without replacement of the stem cells by transplantation, the patient would die of infection or hemorrhage (Assignations Workman, 201 3, p. 85). Stem cells are classified by the source. HOST started with the use of allegoric is transplantation of bone mallow form a sibling or matched unrelated donor and has advanced to the use of human leukocyte antigen(HAL) There is tautologys, in which patient receives their own step cell which are collected before high-doses therapy Lastly, genetics are those that come form identical sibling (Assi gnations Workman, 201 3, p. 85). After, the frozen stem cells are thaw and given as blood transfusions by a central venous catheter or a venous access device. In order for the body to successfully take the transplanted cells a process called engagement is key to the whole transplantation process (Assignations Workman, 2013, p. 887). The period after transplantation is difficult for both the patient and family due to the patient weaken immunity. During and aftermath prevention of complications Life-threatening complications in particular can require complex physical treatment but, more significantly, may arouse complex emotional, psychological and spiritual issues for both patient and nurse. The care focuses on the patient taking chemotherapy and HOST. The most difficult task for the nursing during this processes is maintain hope through this long recovery period. Infections are a major complication in patients with acute myeloid leukemia (ML) undergoing intensive chemotherapy, these complications are still associated with severe morbidity and mortality. Meghan, T et al. (2012) emphasized, Preventing infection is a paramount goal for nurses caring for patients with leukemia. Interruption among hospitalized patients with acute leukemia puts them at a high risk of infection (p. 80). Hand hygiene is to be one of the most effective ways to prevent the transmission of infection. It is important to teach the patient about hand washing to prevent infections while this vulnerable state. Patient should be place in single rooms to prevent cross contamination. The most common infections are fungal, bacteria, and dome residual viral breakthrough (Assignations Workman, 201 3, p. 419). It is important to keep equipment used by the patient in the room, this will ensure there is no contamination. Assisted personal should be taught about washing hands often in between patients and use hand sanitized when you cant use soap and water. Avoid people with colds or the flu, thus, visiting patient should wear a mask at all times. These steps can help reduce the chances of coming into contact with someone who is sick. Patients are wipe out the majority of the time after treatment that self care is often neglected. It is imperative to teach patient, family, and assisted personal that some aspects of personal care cannot be put off for a later time. Mouth care is vital to prevent infection. Brush your teeth after meals and before bedtime, using an extra- soft toothbrush that wont hurt your gums. Inspect mouth for any sores, and report any open sores immediately. Clean your toothbrush at least weekly by either rinsing it liquid laundry bleach and then rinsing the bleach with hot running water. Skin is often the only body part protecting the patient, thus, any break can be a major potential for infection. Bathe regularly with warm water. Be careful to dry your skin completely. Use lotion to prevent cracks in your skin. Open cut and cracks may let bacteria in. Keep your skin hydrated and moisturizer. Dry, cracked skin is more likely to break and become susceptible to infections. Furthermore, squeezing or scratching pimples can rate open sores that would also place you at higher risk of infection. The same is true of biting or tearing at your cuticles. Use an electric razor instead of a blade. This may help you to avoid cuts. Patients should avoid anything raw vegetables, fruit. Cook all food thoroughly. This will help kill any potential germs that may be on raw food. Teach patient to avoid eating raw fruits and vegetables; undercooked meat, eggs, and fish, pepper, apical. The priority nursing interventions for patient with interruption are protecting him or her form infection and teaching patient and family about ways in which they can educe infection. Total patient assessment, including skin, lung, mouth, close inspection of venous access device insertion site(illustrating Workman, 201 3, p. 41 9). The patient should be monitor continuously for infection. Take temperatures according to hospital policy. Monitor the patients CB with differential. Inspect the mouth during every shift for lesions. A complete respiratory assessment should be assess for any presence of crackles, wheezes, and diminish breath sounds. Ask the patient to report any burning, painful urination, also, report any foul odor or cloudiness. It is important to maintain aseptic technique when dealing with central venous devices for dressing changes and administration of chemotherapy drugs at all times. Inspect open areas, such as C.V. every 4 hours for manifestations of infection. Change IV tubing according to hospital protocol. In addition, the patient is also vulnerable from minimal injury. Thermodynamic is defined as a decreased number of platelets in the blood, which can result in poor blood clotting. Thermodynamic is induced by chemotherapy, this poses the patient at great risk for excessive bleeding (Assignations Workman, 201 3, . 89). Patient with thermodynamic often experience include: Easy bruising, bleeding from your nose, rectum (black or bloody bowel movements), or stomach (vomiting blood or coffee-appearing material). Encourage the patient to stand unclothed in front of a mirror once a day to check for areas of bruising. Patchier, which are red spots in the skin. Economies which are larger reddish-blue patch es (bruises) on your skin. In women, periods that are heavier than normal. There are ways to manage this condition, they include: medications that stimulate the formation of platelets. One of this medication is Megan (Assignations Workman, 2013, p. 421) Patient should caution to avoid taking aspirin because it increases risk for bleeding. Patients should use electrical razors. If patient want to blow nose they should do it gently. Also, they should avoid hard food. If patient wears dentures they should fit the mouth properly. If patient want to cut nails they should do so with care. Patient should avoid becoming constipated or straining by taking a stool softener. If any bleeding does occur, instruct the patient to apply pressure to the area and seek help. The most important specs of care of this patient is to maintain a safe, hazardous free environment. Moreover, the patient also suffers from anemia. Normal production of red blood cell is limited with leukemia. Anemia is relatively common in patients who undergo chemotherapy. The goal with anemia is to conserve energy and improve red blood cell counts. Anemia depends on the extend of disease and intensity of treatment. Patients are often left feeling of tiredness which may interfere with every day activities. Fatigue is the most common sign of anemia Patient may become short of breath, dizzy. As Meghan, T et al. 012) advised, Blood transfusions are given to relieve symptoms and improve patients quality of life. (p. 81). Transfusions may be one way to alleviate patients symptoms though the correction effort is fast the duration is limited ant transient. Drug therapy include the administration of arthroscopies-stimulating agent. This agents that boost the production of red blood cells. It is important for nurses to be understanding and helpful during this time of weakness and to reassure patient that is only temporary. There are ways in which nurses can help patient cope with low energy level angina from medication to nursing activities. For example, nursing staff and assisted personnel should space out nursing activities throughout the day and perform any activity possible when the patient has the most energy. It is important to monitor respiratory status during activity to determine if the patient is able to tolerate. Also, nutrition plays a vital role and should be consider because the patient needs enough calories to meet and maintain demand of body. Lastly, malnutrition among patients with leukemia is high. It is very common problem among hospitalized patient, in general; anyway, who wants to eat when sick! It is the nurse, that need to educate abut the importance of nutrition. There are many causes of malnutrition including pain, fatigue, depression, and side effects of chemotherapy. The simple most obvious cause is loss of appetite due to alter taste. Some symptoms include sore mouth, dry mouth, pain, taste and smell changes, diarrhea, fatigue, anxiety, nausea and vomiting. When encourage patient about nutrition modifications is important to keep in mind to include the patient in decision making as much as possible giving a sense of power. Asking the patient about what are some likes and dislikes.