Page 219 - Critical Care Notes

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Acute Lymphocytic Leukemia
■ Reduced leukocytes, erythrocytes, and platelets
■ Bone and joint pain
■ Easy bruising and bleeding (gums, skin, nose, abnormal periods)
■ Feeling weak or tired
■ Fever
■ Loss of appetite and weight loss
■ Paleness
■ Pain or feeling of fullness below ribs
■ Abdominal swelling or left upper quadrant fullness; feeling full after eating
small amounts
■ Petechiae rash
■ Lymphadenopathy (neck, axilla, groin)
■ Night sweats
■ Pain from enlarged liver, or spleen
■ Headache
■ Vomiting
Chronic Lymphocytic Leukemia
■ Asymptomatic in many cases
■ Elevated WBCs
■ Enlarged lymph nodes and spleen
■ Possible development of B-symptoms: fever, night sweats, weight loss,
bacterial infections, and viral infections
Diagnostic Tests
■ CBC with differential
■ Peripheral blood smear
■ Bone marrow aspiration and biopsy
■ Lumbar puncture (to check for leukemia cells in spinal fluid)
■ Immunophenotyping
■ CT
Management
■ Perform daily assessment of body systems.
■ Monitor for anemia and infections.
■ Administer chemotherapy and assess for side effects.
■ Assess for side effects of radiation therapy.
■ Monitor CBC closely.
■ Maintain bleeding precautions.
■ Provide nutritional support.
■ Provide meticulous oral hygiene.
■ Provide perirectal hygiene.
■ Apply mask to patient when out of room.
■ Assess patient’s anxiety level.
■ Monitor intake and output, and assess hydration status.
HEMA/
ONCO