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ACUTE MYELOID LEUKEMIA

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by

Yvon Cu

on 1 April 2014

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Transcript of ACUTE MYELOID LEUKEMIA

NURSING DX
Risk for infection related to abnormal blood profile, secondary to Acute Myeloid Leukemia.
Patient Teaching
A 65-year-old Caucasian male presented to the emergency room with weakness, fatigue, headache, and bruising( developed over the last 8 weeks), an acute onset of bleeding of the gums and shortness of breath.
ACUTE MYELOID
LEUKEMIA

yvon cu

nancy esqueda

kristi wagerle

megan sonsteng

jennifer pineda

jen roodzant

stefanie schiffern

cristal parra

casper suen
Millhouse Van Houten
MRI# 1103880303
DOB: 09/11/1949
ht: 6ft
wt:198lbs
bmi: 26.9

History of:
Diabetes, Hypertension
Chief Complaint:
SOB,
mouth bleeding
Laboratory Values:
Hgb: 5 g/dL Uric acid: 4.9 mg/dL
Hct: 30% Potassium: 6.0 mEq/L
RBC: 2.72
WBC: 14,000 cells/ mm3 with 60% myeloblasts
Platelet count: 95,000/L


Admitting Vitals:

1307:
BP 89/46
PULSE: 113
TEMP: 99.7
RR: 22
SPo2- 87%
EVEREST
HOSPITAL


04/01/14 0945: A renal ultrasound showed no evidence of hydronephrosis.
04/01/14 1925: A bone marrow biopsy is positive for leukemia.
03/31/14
PATHOPHYSIOLOGY
Leukemia is an uncontrolled production of immature WBCs in the bone marrow. Theses immature WBCs take up most of the room, leaving less room for production of normal blood cells.
in acute myeloid leukemia,
the abnormal cells come
from the myeloid patheway
- reduced blood flow
- reduced oxgenation to tissues
- skin cool to touch
- pallor
- decreased bp
- increase heart rate
- shortness of breath, feeling cold
-increased risk for infection
- bruising, bleeding, petechiae
- constipation, reduced bowel sounds, abd. tenderness
- nausea, anorexia, fatigue
- headache, palilledema,
- seizures, coma
**this type of leukemia is acute in that it progresses quickly and may lead to death within weeks if left untreated.
Ineffective Protection related
to abnormal blood profile secondary to Acute Myeloid Leukemia, as evidence by WBC's 47,000 cells/mm3, Monocytes-20%, and Hgb-6g/dl.
Fatigue related to anemia as evidence by patient states, “ I’m so tired all the time” and RBC of 2.72
Don't smoke. People who smoke should get help.

Avoid crowds and sick people.

Inspect all skin surfaces playing close attention to skin folds.

No "live" virus immunization for 2 years following a stem cell transplant or while taking immunosupressive drugs.


No raw fruits, vegetables, and undercooked meats.


Avoid changing litter boxes, reptiles and turtles.

No gardening.

Take good care of your teeth and gums, (no flossing) and use a soft bristled brush.

References
1. Capenito, L. J. (2013).
Nursing diagnosis-application to clinical practice
. (14th ed.) Philadelphia, PA: Lippincott Williams & Wilkins.

2. Ignatavicius D. D., & Workman, L. M. (2013).
Medical surgical nursing: Patient-centered collaborative care
. St. Louis, Missouri. Elseiver Saunders.

3. Mayo Clinic Staff. (2012, Septemeber 15).
Acute myelogenous leukemia
. Retrieved from http://www.mayoclinic.org/diseases-conditions/acute-myelogenous-leukemia/basics/coping-support/con-20043431
1. Demonstrate proper technique for hand hygiene. Allow patient to do return demonstration.
2. Instruct all staff and family to carefully wash hands.
3. Limit visitors to immediate family at the present.
4. Place patient in a private room.
5. Monitor patient for signs/symptoms of an infection; fever, redness/swelling, acute confusion, etc.
1. Provide periods of rest alternating with activities.
2. Administer prescribed medication to treat anemia.
3. Minimize environmental activity and noise.
4. Assist patient with ADL's as needed.
5. Instruct patient in energy-saving techniques (e.g. using shower chair when showering, sitting to brush teeth or comb hair)

1. Avoid invasive procedures unless absolutely necessary.
2. Assess patient for abnormal bleeding, for example- nose bleeds, petechiae, purapura and abnormal bruising.
3. Advise patient to adopt safely practices about self-care activities. (use an electric razor, soft bristle toothbrush)
4. Educate patient on medications, beverages, and foods to avoid that can potentially increase risk for bleeding. For example, Aspirin, NSAIDS, alcohol, gingko biloba and poor nutrition.
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