disorder of the white blood cells (WBCs)

manifestations of infection

• neuro

• temp

• oral mucosa

• skin

• resp.

• GI

• GU

neutropenia

abnormally low absolute neutrophil count (ANC) less than 2,000/mm3. result of decreased prod. of neutrophils or increased destruction of cells. associated with RISK OF INFECTION

• below 1500 cells, risk of infection rises

• less than 500 cells: high risk

• less than 100 cells: greatest risk of infection

(increased duration of neutropenia, increases risk of infection)

assessment & diagnostic findings:

• no definitive symptoms until patient develops an infection

• CBC with ‘diff’

medical management:

• discontinue med

• corticosteroids

• growth factor (GCS-F: Filgrastim)

• witholding/reducing chemo

• febrile neutropenia

  -cultures (blood, sputum, urine), CXR
  -antibiotics

nursing management:

• neutropenic precautions: initiated when ANC is less than 1,000 cells
  -private room, precautions sign on door

  -mask when leaving room

  -proper hand hygiene/standard precautions

  -staff/visitors with a contagious illness restricted

  -follow institution policy

• check VS and temp q4h

• monitor WBC with diff daily

• administer filgrastim as prescribed

• avoid rectal/vaginal procedures

• use oral stool softeners

• assist pt with personal hygiene

• instruct pt to use electric razor

• encourage ambulation is room

• change water pitcher, denture cleaning fluids, and respiratory equipment daily

• assess IV sites daily

• encourage IS

• fluid intake

• no IM injections nor CATH

• no plants, fresh fruit

-patient education/discharge planning

• maintain good hand hygiene, personal hygiene, oral hygiene, skin integrity

• avoid cleaning birdcages & pet litter boxes

• avoid garden work

• high cal, high protein diet

• fluid intake @ least 3L a day

• no large crowds

• deep breathing & IS

• no vaginal or rectal manipulation during sex

• discuss dental procedures with providers

• provide fam & patient ed on food hygiene & safe food handling

• REPORT S/S of infection ASAP to provider

leukemia

unregulated proliferation of leukocytes in bone marrow, leads to overcrowding, leaving little room of normal cell production. can affect other organs in body such as liver, spleen, lymph nodes, and skin

• occurs in all age groups: acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL)

• no single causative agent

  -risk factors include prior radiation and chemotherapy, smoking, occupation and chemical exposure, increasing age, family hx, and certain genetic disorders

clinical manifestations

L: lymph node swelling
E: enlargement of spleen and liver
U: unexplained weight loss, fever
K: K as in WeaKness
E: easily bleeding & bruising
M: midnight sweats
I: infections
A: anemia s/s, appetite loss

diagnostic procedures

• CBC w/ diff, coagulation studies, cytogenic studies, creatinine, electrolytes, LFTs, and C&S

• bone marrow biopsy or aspiration will confirm diagnosis

patient problems

• risk for infection and/or bleeding

• impaired nutritional status

• acute pain

• fatigue and activity intolerance

• fluid imbalance

• impaired ability to perform hygiene, dress, self-toileting

• anxiety and grief

• risk for spiritual distress

• lack of knowledge

planning/goals

• absence of complications and pain

• maintenance of adequate nutrition and activity tolerance

• ability to provide self care and cops with diagnosis and prognosis

• positive body image

• understanding of disease process and tx

medical management

• combination chemotherapy

• immunotherapy

• targeted cell therapy

• radiation therapy

• hematopoietic stem cell transplant

nursing interventions/care

• diminish risk of infection & bleeding

  -neutropenic precautions

  -bleeding precautions

• managing mucositis

• improving nutritional intake

• easing pain & discomfort

• decreasing fatigue & activity intolerance

• maintaining fluid & electrolyte imbalance

• improving self care

• managing anxiety and grief

• encourage spiritual well-being

lymphoma

a neoplasm of lymphocyte cells. cells overgrow & multiply causes tumors within lymph nodes, lymphomas can metastasize to almost any organ

hodgkin lymphoma

• arises in single location, spreads along adjacent lymphatics

• 15-35 years of age, more than 50

• 2x in males

• weight loss, fatigue, weakness, fever, chills, tachycardia, night sweats, alcohol induced pain, generalized pruritus w/out lesions

• reed-sternberg cells

• chemo & radiation

• monoclonal aB

• high dose chemo & stem cell transplant

non-hodgkin lymphoma

• older than 60

• exposed to certain chemicals, radiation exposure

• immune system deficiency and HIV infection

• enlarged lymph nodes, swollen abdomen, feeling full after only a small amount of food. chest pain or pressure. SOB or cough

• more than 3 types of NHL

• chemo, radiation, immunotherapy, targeted therapy, stem cell transplant

multiple myeloma

malignant disease of the most mature form of B lymphocyte- the plasma cell. the malignant plasma cells produce a specific immunoglobin that is nonfunctional, referred to as the monoclonal protein or M protein

-these malignant plasma cells build up in the bone marrow and form tumors in many bones in the body
-multiple myeloma may evolve from a precursor condition known as monoclonal gammopathy of undetermined significance (MGUS) and the next stage, smoldering (or asymptomatic) multiple myeloma SMM

risk factors

• increasing age

• fam hx

• male gender

• african americans

• exposure to radiation, chemicals

• obesity

• plasma cell disease hx

clinical manifestations/assessment

C: as in hyperCalcemia
R: renal dysfunction
A: anemia
B: bone destruction

diagnostic findings

• CBC with diff, BUN, creatinine, creatinine clearance, electrolytes, LDH

• total protein level, electrophoresis, urine protein level

• cytogenic studies

• CT scan, MRI, PET scan

• BMA or biopsy

medical management

• NO CURE

• hematopoietic stem cell transplant (bone marrow)

• chemo, steroids, monoclonal aB, immunomodulary drugs

nursing management

• pain management

  -opioids or NSAIDs as prescribed

• preventing infection

• activity/mobility assistance to prevent pathologic fractures (braces, 10 lb. lifting restriction, gentle repositioning)

• oral hygiene

• monitoring renal function, fluid & electrolytes

• VTE prevention

• monitoring sensory motor function

• patient education on preventing infection, blood clots, sensory motor impairment, pain management, as well as s/s

HYPERCALCEMIA INTERVENTIONS

• maintain pt safety & ease comfort

• ECG monitoring

• 3-4L daily fluid intake

• biphosphate therapy

• encourage mobilization & weight bearing activities as tolerated

• high fiber diet/stool softeners/laxatives for constipations

• antiemetics for n/v

• avoid dietary supplements and meds that increase serum Ca lvls