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2 Nanda Nursing Diagnosis and Interventions for Leukemia

Leukemia

Definition

Leukemia is a neoplasm of acute or chronic blood-forming cells in bone marrow and spleen (Reeves, 2001). The other characteristic of leukemia is the proliferation of irregular or accumulation of white blood cells in bone marrow, replace normal bone marrow elements. Proliferation also occurs in the liver, spleen, and lymph nodes. The invasion of non-haematological organs such as the meninges, gastrointestinal tract, kidney, and skin.

Acute lymphocytic leukemia (ALL) often occurs in children. Leukemia classified as acute if there is proliferation of the blastocyst (young blood cells) from bone marrow. Acute leukemia is a malignant primary bone marrow resulting in normal blood components late decision by abnormal blood components (blastocyst), accompanied by the spread of other organs. Leukemia is classified as chronic if found cell expansion and accumulation of old and young cells (Tejawinata, 1996).

In addition to acute and chronic, there is also a congenital leukemia is leukemia were found in infants aged 4 weeks or younger infants.


Etiology

The cause of ALL until now not clear, but most likely due to a virus (oncogenic viruses).

Other factors that play a role include:
  1. Exogenous factors such as X rays, radioactive rays, and chemicals (benzol, arsenic, sulfate preparations), infections (viruses and bacteria).
  2. Endogenous factors such as race
  3. Constitutional factors such as chromosomal abnormalities, hereditary (sometimes encountered cases of leukemia in siblings or twins one egg).

Predisposing factors:
  1. Genetic factors: a certain virus causes changes in gene structure (T cell leukemia-lymphoma virus / HTLV)
  2. Ionizing radiation: the work environment, prenatal care, previous cancer treatment
  3. Exposure to chemicals such as benzene, arsenic, chloramphenicol, phenylbutazone, and anti-neoplastic agents.
  4. Immunosuppressive medications, drugs carcinogens such as diethylstilbestrol
  5. Hereditary factors such as the twins one egg
  6. Chromosomal abnormalities

If the cause of leukemia is caused by a virus, the virus will easily fit into the human body if the structure of the viral antigen is consistent with the structure of the human antigen. The structure of the human antigen is formed by the antigen structure of various organs, especially the skin and mucous membranes located on the surface of the body (tissue antigen). By WHO, tissue antigens defined by the term HL-A (human leucocyte locus A).


Signs and Symptoms

1. Anemia
Caused by red blood cell production is less a result of the failure of the bone marrow to produce red blood cells. Characterized by reduced hemoglobin concentration, a decrease in hematocrit, red blood cell count less. Children with leukemia have pale, tiredness, shortness of breath sometimes.

2. High body temperature and easy to infections
Due to a decrease in leukocytes, it will automatically lower the body resistance due to leukocytes serves to maintain the immune system can not work optimally.

3. Bleeding
Signs of bleeding can be viewed and analyzed from the presence of mucosal bleeding such as gums, nose (epistaxis) or bleeding under the skin which is often called petechiae. Bleeding may occur spontaneously or due to trauma. If very low levels of platelets, bleeding can occur spontaneously.

4. Decreased consciousness
Due to infiltration of abnormal cells to the brain can cause a variety of disorders such as seizures to coma.

5. Decrease in appetite

6. Weakness and physical exhaustion.



Clinical Manifestation

Typical symptoms of pale (may occur suddenly), body heat, and bleeding accompanied by splenomegaly and sometimes hepatomegaly and lymphadenopathy. Bleeding can be diagnosed ecchymoses, petekia, epistaxis, bleeding gums, etc..
Symptoms are not typical is joint pain or bone pain can be mistaken for rheumatic diseases. Other symptoms can arise as a result of infiltration of leukemic cells in organs such as purpuric lesions on the skin, pleural effusion, cerebral seizures in leukemia.


2 Nursing Diagnosis and Interventions for Leukemia

1. Risk for Fluid Volume Deficit

related to
  • fluid intake and output,
  • excessive loss: vomiting, bleeding, diarrhea
  • decrease in fluid intake: nausea, anorexia
  • increased need for fluids: fever, hypermetabolic.

Purpose : the volume of fluid being met

Expected outcomes:
  • Adequate fluid volume
  • The mucosa moist
  • Vital signs are stable: BP 90/60 mm Hg, pulse 100x/menit, RR 20x/menit
  • Pulse palpated
  • Urine output 30 ml / hour
  • Capillaries and refill less than 2 seconds
Intervention:
  • Monitor fluid intake and output
  • Monitor body weight
  • Monitor BP and heart frequency
  • Evaluation of skin turgor, capillary refill and mucous membrane conditions
  • Give fluid intake 3-4 L / day
  • Inspection of skin / mucous membranes for petechiae, ecchymoses area; noticed bleeding gums, blood color of rust or vague in feces and urine, bleeding from the puncture further invasive.
  • Implement measures to prevent tissue injury / bleeding
  • Limit oral care to wash mouth when indicated
  • Give diet a smooth
  • Collaboration:
    • Give IV fluids as indicated
    • Supervise laboratory tests: platelet count, Hb / Ht, freezing
    • Provide HR, platelets, clotting factors
    • Maintain a central vascular access device external (sub-clavicle artery catheter, tunneld, implantable ports)
2. Acute pain 

related to an agent of physical injury

Purpose: pain is resolved

Expected outcomes:
  • The patient stated the pain disappeared or controlled
  • Shows the behavior of pain management
  • Looks relaxed and able to rest, sleep

Intervention:
  • Assess complaints of pain, notice changes in the degree of pain (using a scale of 0-10)
  • Monitor vital signs, note the non-verbal clues such as muscle tension, anxiety
  • Provide quiet environment and reduce stressful stimuli.
  • Place the client in a comfortable position and prop joints, extremities with pillows.
  • Change the position of periodic and soft assistive range of motion exercises.
  • Provide comfort measures (massage, cold compresses and psychological support)
  • The review / enhance client comfort interventions
  • Evaluate and support the client's coping mechanisms
  • Encourage the use of pain management techniques. Example: relaxation exercises / breathing in, touch.
  • Auxiliary therapeutic activity, relaxation techniques.
  • Collaboration: Monitor levels of uric acid, give the medication as indicated.

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