Nursing care for Leukemia

Summary

In this video, Professor D covers leukemia, explaining its definition, types, and impact on the blood and immune systems. He outlines the difference between acute myelogenous leukemia (AML), which mostly affects adults, and acute lymphocytic leukemia (ALL), more common in children. The video discusses leukemia's effects, such as increased immature white blood cells, bone marrow failure, and the associated risks of infection, anemia, and bleeding. Professor D also offers nursing interventions, diagnostic methods, and tips for managing chemotherapy side effects. He emphasizes patient independence, mental health, and a multi-disciplinary approach to treatment.

Takeaways

• 🔔 The presenter encourages viewers to like, subscribe, and engage with the video for better channel support and future updates.
• 💉 Leukemia is a malignant disorder affecting blood, bone marrow, lymph system, and spleen, leading to high risks of infections, anemia, and bleeding.
• 🦠 Leukemia involves an increase in immature white blood cells (WBCs) that do not function properly, taking up space that should be occupied by healthy cells.
• 📊 Chronic leukemias develop slowly and affect more mature WBCs, while acute leukemias have a sudden onset with more serious symptoms.
• 👩‍⚕️ Acute Myelogenous Leukemia (AML) commonly affects adults, causing abrupt, serious infections and abnormal bleeding due to overcrowding of bone marrow by myeloblasts.
• 👶 Acute Lymphocytic Leukemia (ALL) primarily affects children, with key symptoms including fever, CNS involvement, and neurological issues like increased intracranial pressure.
• 🦴 Bone marrow failure in leukemia leads to overcrowding by abnormal cells, reducing normal blood cell production and causing anemia, infections, and bleeding issues.
• 🧬 Leukemic cells infiltrate other organs, potentially causing splenomegaly, hepatomegaly, bone pain, and other organ-related issues, including life-threatening blood thickening (leucostasis).
• 🧑‍⚕️ Diagnosis of leukemia primarily involves peripheral blood evaluation and bone marrow examination, followed by treatment aimed at achieving remission, usually with chemotherapy.
• 👨‍👩‍👧‍👦 An inter-professional team, including oncology specialists, dietitians, psychiatrists, and social workers, is essential for managing the medical, emotional, and financial aspects of leukemia care.

Q & A

What is leukemia, according to the script?

Leukemia is a group of malignant disorders affecting the blood, blood-forming tissues of the bone marrow, lymph system, and spleen. It involves the proliferation of immature white blood cells (WBCs), which are non-functional and take up space that could be occupied by healthy red blood cells (RBCs) and platelets.

Why are patients with leukemia at high risk for infections?

Patients with leukemia are at high risk for infections because their bone marrow produces an excessive number of immature white blood cells, which are ineffective at fighting off infections. This leads to immunosuppression and makes the patient vulnerable to infections.

How does leukemia lead to anemia and bleeding tendencies?

Leukemia leads to anemia because the proliferation of immature white blood cells crowds out the space needed for the production of red blood cells, which carry oxygen. It causes bleeding tendencies because the bone marrow also fails to produce enough platelets, which are necessary for clotting.

What is the difference between acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL)?

AML primarily affects adults, has an abrupt and dramatic onset, and leads to serious infections and abnormal bleeding due to uncontrolled proliferation of myeloblasts. ALL, on the other hand, is more common in children, and symptoms can be either abrupt or gradual. ALL frequently involves CNS manifestations, such as leukemic meningitis, and causes fatigue, weakness, and bleeding.

What are some clinical manifestations of leukemia?

Clinical manifestations of leukemia include anemia, immunosuppression, fatigue, weakness, bleeding tendencies, and CNS involvement (especially in ALL). The bone marrow becomes overcrowded with abnormal cells, leading to decreased production of healthy blood cells. Leukemic cells may also infiltrate other organs, causing issues like splenomegaly, hepatomegaly, and lymphadenopathy.

What diagnostic methods are used to confirm leukemia?

Peripheral blood evaluation and bone marrow examinations are the primary diagnostic methods used to diagnose and classify leukemia. These tests help determine the presence and type of leukemia.

Why is chemotherapy a key treatment for leukemia, and what are its side effects?

Chemotherapy is a mainstay treatment for leukemia because it targets and kills rapidly dividing cancer cells. However, it can also damage healthy cells, leading to side effects such as mucositis, stomatitis, nausea, vomiting, diarrhea, constipation, alopecia, and cognitive changes like 'chemo brain.'

What interventions can help manage the side effects of chemotherapy in leukemia patients?

Interventions to manage chemotherapy side effects include: assessing oral mucosa for lesions, providing nutritional supplements, recommending soft and bland foods, avoiding irritating or spicy foods, administering antiemetics before chemotherapy, encouraging fluid intake for diarrhea, and advising the use of wigs or scarves for hair loss.

What are the nursing priorities for patients with leukemia?

Nursing priorities include maximizing the patient’s physical functioning, educating the patient about the temporary nature of acute side effects from treatment, promoting independence, and encouraging discussions about quality-of-life issues and long-term care planning.

How does the inter-professional team support the care of leukemia patients?

An inter-professional team, including psychiatrists, oncology specialists, case managers, dietitians, chaplains, and social workers, collaborates to address the physical, emotional, spiritual, and social needs of leukemia patients. This team ensures comprehensive care and support, particularly in managing side effects, emotional distress, financial issues, and transitions in care.

Outlines

00:00

🎥 Introduction and Channel Support

Professor D welcomes viewers to the channel and introduces the topic of leukemia. She emphasizes the importance of liking the video, subscribing to the channel, and engaging in the comments section, as it supports the channel’s growth and helps with the algorithm. She also mentions additional audio lessons available on her website and expresses her commitment to responding to comments and making requested videos.

05:02

🩸 Understanding Leukemia

Leukemia is introduced as a term describing a group of malignant disorders affecting blood, bone marrow, lymph system, and spleen. The discussion highlights that leukemia patients are at high risk for infections, anemia, and bleeding due to immature white blood cells (WBCs) that cannot perform their function of fighting infections. The classification of leukemia is then explained, noting that chronic leukemias involve mature forms of WBCs and develop gradually. Specific types such as AML (acute myelogenous leukemia) and ALL (acute lymphocytic leukemia) are described, noting their prevalence in adults and children, respectively, and the serious implications of immature cell proliferation in the body.

10:03

🧠 Leukemia Symptoms and Classification

The differences between AML and ALL are further elaborated, focusing on how ALL affects children more frequently and includes CNS involvement, which can lead to cognitive issues and increased intracranial pressure. Both AML and ALL can cause symptoms such as fever, fatigue, bleeding, and bone pain due to abnormal cell infiltration in bone marrow and other tissues. Leukemia leads to overcrowding in the bone marrow, affecting the production of healthy cells and contributing to anemia, thrombocytopenia, and increased infection risks.

15:04

📉 Leukemia Impact on Body Functions

The impact of leukemia on various body systems is discussed. The proliferation of immature WBCs disrupts normal blood cell production, leading to symptoms like anemia, immunosuppression, and bleeding disorders. The infiltration of leukemic cells into other body parts, including the brain and organs, is highlighted. The importance of understanding diagnostic tools, such as blood smear and bone marrow evaluation, is noted, as well as the role of chemotherapy in managing leukemia despite its side effects on healthy cells.

20:05

💉 Managing Chemotherapy Side Effects

The side effects of chemotherapy, such as stomatitis, nausea, and anorexia, are detailed along with nursing management strategies. Recommendations include maintaining oral hygiene, encouraging small, high-protein meals, and managing nausea with antiemetics. Special attention is given to managing leukopenia, thrombocytopenia, and alopecia, which are common in chemotherapy patients. The need for a supportive environment and specialized care plans to help patients cope with both physical and cognitive changes during treatment is stressed.

🧠 Coping with Cognitive Changes and Patient Care

The concept of ‘chemo brain’ is introduced, highlighting cognitive challenges such as memory loss and difficulty focusing. Suggestions for patients include using detailed planners, engaging in brain exercises, and avoiding multitasking. Nursing interventions are emphasized, including maximizing physical functioning, educating patients about the temporary nature of treatment side effects, and encouraging discussions on quality-of-life issues. The importance of a multidisciplinary approach to meet the holistic needs of leukemia patients is underscored, involving specialists such as psychiatrists, dietitians, and social workers.

💡 Key Nursing Interventions and Team Support

Nursing interventions for leukemia patients focus on managing life-threatening symptoms like neutropenia, thrombocytopenia, and anemia. Patients are encouraged to engage in self-care, understand the temporary nature of side effects, and participate in decision-making regarding their treatment. A comprehensive support team is recommended, including professionals to address medical, psychological, nutritional, and spiritual needs, ensuring continuous and coordinated care for patients navigating leukemia treatment.

Keywords

💡Leukemia

Leukemia is a group of malignant disorders affecting the blood and blood-forming tissues, including bone marrow, the lymphatic system, and the spleen. In the video, leukemia is described as a condition characterized by an increase in immature white blood cells (WBCs) that are non-functional, which leads to complications like infections, anemia, and bleeding. It serves as the core topic of the video.

💡Immature White Blood Cells (WBCs)

Immature WBCs are abnormally formed white blood cells that are unable to fight infections effectively. In leukemia, there is an overproduction of these immature cells, which occupy space meant for healthy red blood cells and platelets. This concept is key to understanding why leukemia patients are at higher risk for infections and anemia.

💡Bone Marrow

Bone marrow is the tissue in the body where blood cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets, are produced. Leukemia disrupts normal bone marrow function, leading to overcrowding by immature WBCs, which hinders the production of healthy cells. This process explains the root cause of many symptoms in leukemia patients, such as anemia and thrombocytopenia.

💡Anemia

Anemia is a condition where the body lacks enough healthy red blood cells to carry adequate oxygen to the tissues, leading to fatigue and weakness. In the context of leukemia, the excessive growth of immature WBCs reduces the space available for RBC production, which leads to anemia. It is one of the significant side effects of leukemia described in the video.

💡Thrombocytopenia

Thrombocytopenia refers to a deficiency of platelets, which are cells that help blood clot. In leukemia, the bone marrow becomes crowded with non-functioning WBCs, limiting the production of platelets. This condition results in an increased risk of bleeding disorders, a critical point highlighted in the video.

💡Acute Myelogenous Leukemia (AML)

AML is a type of leukemia that primarily affects adults and is characterized by the rapid growth of immature myeloblasts, a type of WBC precursor. The video explains that AML has an abrupt and severe onset, often leading to infections and abnormal bleeding. Understanding AML is crucial because it contrasts with other forms of leukemia in terms of patient demographics and disease progression.

💡Acute Lymphocytic Leukemia (ALL)

ALL is a form of leukemia that primarily affects children, characterized by the proliferation of immature lymphocytes in the bone marrow. It is often associated with symptoms like fever, bone pain, and bleeding. The video emphasizes the importance of recognizing ALL's neurological symptoms, which result from central nervous system involvement, making it distinct from other types of leukemia.

💡Central Nervous System (CNS) Manifestations

CNS manifestations refer to neurological symptoms caused by the infiltration of leukemic cells into the brain and spinal cord. In ALL, this can lead to increased intracranial pressure, cognitive decline, and other severe neurological symptoms like cranial nerve dysfunction. The video highlights the seriousness of these manifestations in children with ALL.

💡Chemotherapy

Chemotherapy is the primary treatment for leukemia, aiming to destroy cancer cells. However, as the video notes, chemotherapy can also damage healthy cells, leading to side effects such as infections, bleeding, and gastrointestinal issues. Understanding chemotherapy's dual effects—both therapeutic and harmful—is crucial for managing leukemia treatment.

💡Remission

Remission is the goal of leukemia treatment, where the disease's symptoms and signs are reduced or disappear entirely. The video stresses that the initial treatment goal for leukemia patients is to achieve remission, primarily through chemotherapy. Remission doesn't necessarily mean a cure but is a critical milestone in managing leukemia.

Highlights

Leukemia is a group of malignant disorders affecting blood and blood-forming tissues, including bone marrow, lymph system, and spleen.

Leukemia patients are at high risk for infections, anemia, and bleeding due to a lack of functional blood cells.

Leukemia involves an increase in immature white blood cells (WBCs) that can't fight infections or perform normal functions.

The proliferation of immature WBCs takes up space needed for healthy RBCs and platelets, leading to complications such as anemia and bleeding.

Chronic leukemias involve more mature WBCs and develop gradually, while acute leukemias have a sudden onset and dramatic symptoms.

Acute myelogenous leukemia (AML) affects adults more frequently, with an abrupt onset and symptoms such as serious infections and abnormal bleeding.

Acute lymphocytic leukemia (ALL) affects children more frequently and is characterized by CNS involvement, which can cause neurological symptoms like increased intracranial pressure.

Bone marrow failure in leukemia results in overcrowding by abnormal cells, leading to a lack of space for normal blood cells and causing anemia, thrombocytopenia, and immune suppression.

Leukemic cells may infiltrate organs such as the spleen, liver, and lymph nodes, causing organ enlargement and additional complications.

A highly leukemic white blood cell count (over 100,000) can cause leukostasis, a life-threatening condition where blood thickens and circulation is blocked.

Chemotherapy is the main treatment for leukemia, but it can cause side effects like stomatitis, esophagitis, nausea, vomiting, and cognitive changes (chemo brain).

Nursing management includes monitoring oral health, avoiding irritating foods, encouraging small frequent meals, and preventing dehydration in patients with chemotherapy side effects.

Leukopenia, thrombocytopenia, and neutropenia are critical issues in leukemia patients, increasing the risk of infections, bleeding, and anemia.

Patients undergoing chemotherapy should be encouraged to focus on one task at a time, use detailed planners, and play word games to mitigate cognitive challenges.

The interprofessional team for leukemia patients includes oncology specialists, dietitians, chaplains, psychiatrists, and social workers to address the medical, emotional, and financial aspects of care.

Transcripts

hi guys it's me Professor D and welcome

back to my YouTube channel on this video

I'm going to be covering leukemia as

promised before we even get started guys

I'm going to actually do a couple things

for me to help support this channel like

this video You're gonna love it so go

ahead press that like button subscribe

to this channel if you haven't done so

already and you'll be notified every

time a new video is released don't

forget I have audio lessons available

for you on my website

nexusnursinginstitute.com and please as

always engage with me in the comment

section it helps with the algorithm I

read all of your comments I try to

respond to as many as possible but I

definitely read the comments and I have

a running list going of any videos that

you'd like for me to make in the future

whether they're questions or content

lesson format like I'm doing right now

all right guys so let me make this a

little bit bigger for you

foreign

so look what it says it says leukemia

this is a general term used to describe

a group of malignant disorders now I

already talked to you guys about

malignancy malignant disorders affecting

blood and blood forming tissues of the

bone marrow lymph system and spleen that

says a lot to us

of the bone marrow remember those are

where our blood cells are being made

rbcs

so you'd be thinking of anemia platelets

patient be at risk for bleeding uh WBC

patient B risk for what infection

lymph system and spleen what are those

important immunity so this person with

leukemia we already know just by that

one sentence we know they're going to be

at high risk for infections for anemia

for bleeding right so take a look I

wrote this down because I just wanted

you to know it in simpler terms leukemia

this is an increase in and that's your

keyword immature

immature wbcs so you have all of these

wbcs that are doing absolutely nothing

remember those wbcs those white blood

cells are supposed to help you fight off

infection so you would think the more

wbcs you have okay even better you're

fighting off infection even more but no

all of those wbcs that increase

in the production of RBC uh rbcs and the

production of wbcs is for nothing why

because they're immature they can't do

nothing

okay increase in immature w3s wbc's the

take up space

that there could have been rbcs there

could have been platelets right so it's

taking up space and doing absolutely

nothing that's what's happening in

leukemia

let's take a look at classification

the leukemia develops after a malignant

transformation of a single type of

immature hemopoetic cell followed by

cellular replication and expansion of

that malignant clone so it keeps

reproducing keeps reproducing but

they're all what immature

chronic leukemias involve more mature

forms of the WBC and the disease onset

is more gradual and that's actually a

pattern for when it comes to chronic

diseases and disorders they're more

Insidious they don't

um uh um uh what's the word I'm looking

for

they're not acute chronic disorders are

more gradual they're more Insidious they

just kind of like creep up on you versus

acute Okay

we have AML and a l l so we're going to

talk about the AML first acute

myelogenous leukemia and on the side I

wrote here more adults because when you

think of the AML I want you to think

about adults adults are affected more

with this disease than children okay

with AML the onset is abrupt as in acute

like that it's abrupt and dramatic

patients may have serious infections and

abnormal bleeding

why serious infections because it's got

wbcs It's not doing anything why

abnormal bleeding remember in the bone

cells what's made are rbcs our wbcs and

our platelets our platelets which help

us clot and not bleed to death

okay so now you have all these wbcs

taking spaces taking the space of what

should have been normal healthy cells of

course yes that's going to put the

patient at risk for and males

characterized by uncontrolled

proliferation of myeloblast which are

the precursors of granulocytes

there's hyperplasia of the bone marrow

the clinical manifestations are usually

related to replacement of the normal

hematopoetic cells in the bone marrow by

leukemic myeloblast and to a lesser

extent infiltration of other organ and

tissues

so these cells which are doing nothing

but causing harm are taking place of

where other normal cells should have

been it's not only happening in the bone

marrow it's also happening in other

tissues and organs and we'll look at

that in a second

now let's look at all when you think of

a l l c on the side I wrote what did I

write on the side I wrote more children

this affects children more than it does

adults okay

in all the acute lymphocytical leukemia

small lymphocyte proliferate in the bone

marrow most are B cell origin the

majority of patients have a fever at the

time of diagnosis signs and symptoms may

appear abruptly with bleeding you need

to know that fever or they may be

Insidious that word Insidious means

sneaky right they may be Insidious with

Progressive weakness fatigue bone and or

joint pain and bleeding Tendencies You

need to know that CNS manifestations are

especially common in all and they

represent a serious problem

leukemic meningitis caused by arachnoid

infiltration occurs in many patients

with all so let's take a look let's take

a look at the difference between our AML

and the all

something I want to bring to your

attention I'm not going to read all of

this guys you can read that on your own

but something I want to bring to your

attention when it comes to the AL member

of the AL we see this more in what

children right look at these

neurological manifestations

CNS involvement and whenever that CNS is

involved you're expecting to see a

decrease in cognition how the person

thinks look at this increased

intracranial pressure and that could

cause the nausea

vomiting lethargy cranial nerve

dysfunction secondary to meningo

infiltration

okay other signs and symptoms that you

can see in both is going to be your

weakness your fatigue your bleeding okay

those you'll see in both but

specifically for the all I want you to

remember that children are more affected

and I want you to remember those

neurological manifestations

foreign

clinical manifestation signs and

symptoms

all right clinical manifestations they

relate to the problems caused by bone

marrow failure and the formation of

leukemic infiltrates bone marrow failure

results from one the bone marrow look at

that guys overcrowding

overcrowding by abnormal cells which

means there's no room for the actual

good cells that are functioning and two

inadequate production of normal marrow

elements so what happens after a while

of the body making all of this abnormal

um cells the bone marrow will actually

slow down or even stop making the normal

cells because you already have so much

of it even though it's abnormal

the price the patients predisposed to

anemia why are they predisposed to

anemia because of the decrease in RBC

remember rbc's carry hemoglobin

hemoglobin carries what oxygen

thrombocytopenia why because in the

decreased number of platelets and

decreasing the number of function of

wbcs and we know that because in

leukemia all it is is a proliferation an

increase in immature wbcs

the abnormal wbcs continue to accumulate

because they do not go through the

normal life cycle to death the leukemic

cells May infiltrate the patient's

organs leading to problems such as

splenomegaly when it gets into Sweden

hepatomegaly when it gets into the liver

lymphadenopathy when it gets into those

lymph nodes bone pain a meningo

irritation and oral lesions

a highly leukemic white count in the

peripheral blood more than a hundred

thousand can cause the blood to thicken

and potentially block circulatory

Pathways guys remember the blood is

what's carrying oxygen the tissues the

organ every Sun the body needs oxygen to

survive okay so this is called

leucostasis and it can be

life-threatening that can cause the

patient to die

take a look at this figure

so it says leukemia proliferation of

immature that's our keyword immature

white blood cells

and over here bone marrow failure blast

cells replace bone marrow

and look how it's affected

the erythrocytes

can cause anemia the causes that patient

to have the weakness and Power

it affects the lymphocytes that causes

immunosuppression remember I told you

how the those lymph nodes in the spleen

are associated with with what immunity

so when it affects those lymph nodes you

better uh you better expect that

patient's going to have

immunosuppression which puts them at

risk for infection

fever

platelets

remember in the bone marrow guys WBC RBC

and platelets are formed so it affects

the platelets which causes decreased

bleeding which decrease bleeding

decreased clotting excuse me

and that decreased clothing puts the

patient at risk for what bleeding

disorders

patient has a thrombocytopenia thrombo

clot cytol that cell penny a little bit

of a little bit of clot cells that's

what platelets and we'll see petite

bruising and purpura

now on this side because of leukemia

that proliferation of immature white

blood cells the cells infiltrate sites

outside of the bone marrow as well such

as what the brain

and that's how you will see all those

CNS symptoms

testicles other

um organs lymph nodes liver spleen and

Joints guys I know as students um you

love skipping over those tables those

diagrams those charts those figures

those illustrations uh those nursing

alerts but guess what those are where

your test questions are coming from

if the author of the book took time

to give you an illustration or chart or

table or figure whatever it is to give

you another way of looking at

information that they gave to you in

text that means it's important it's so

important that giving it to you in

another format because they really want

you to know it most likely you're going

to see it on an exam so stop skipping

over them guys

all right diagnostic

studies

peripheral blood evaluation and bone

marrow examinations okay those are the

primary methods used for diagnosing and

classifying the types of leukemia okay

peripheral blood smear and bone marrow

evaluation

foreign

once the diagnosis of leukemia has been

made care is focused on the initial goal

of attaining remission

because chemotherapy is a Mainstay of

treatment you have to understand the

principles of

um cancer chemo so I'm going to jump

over to those principles because there

are lots of

things that can happen with chemo

because chemo yes chemo can kill those

bad cells but they can also kill those

good cells as well and so they can cause

other disorders in the patient you have

to know how to care for them so let me

switch over and then I'll come back here

let me fold this over so I don't forget

where I was

all right so let's start with the GI

system the stomatitis mucosa mucositis

esophagitis

nursing management for those

make sure you're always assessing the

patient's oral mucosa you're going to be

looking for lesions encourage

nutritional supplements why because if

that patient has those oral lesions you

think they're going to want to eat no

and remember nutrition is part of

physiological Integrity that is part of

the things that keeps the patient alive

so they have to eat so you can encourage

them to drink maybe ensure Carnation

Instant Breakfast

instruct them to avoid irritating spicy

or acidic Foods or foods that are too

hot or too cold remember they have

lesions in their mouth it's already

painful for for them so you don't want

them eating anything that's spicy or too

hot okay teach them to avoid extremes in

temperature

instruct them how to select moist Bland

and softer Foods we want foods that are

very easy for them to chew that will not

irritate their oral mucosa that's

already irritated encourage your patient

to use artificial saliva to manage

dryness from the radiation

discourage your use of irritants such as

tobacco and alcohol stay away from them

all right for nausea and vomiting nausea

and vomiting is a very common adverse

effect of a chemotherapy radiation

you're going to encourage the patient to

eat and drink when they're not nauseated

and you're going to give

anti-medics prophylactically before

chemo we know chemo causes nausea and

vomiting so before chemo we're going to

go ahead and give them that antiemetic

prophylactically

for anorexia patient doesn't want to eat

we're going to be monitoring their

weight we're going to encourage the

patient to eat small frequent meals

small frequent meals is good for GI

irritation okay but those smart frequent

meals we want them to be high in protein

why protein is not only good for

building muscle protein is also good for

wound healing

okay we're going to ask them to eat high

protein and high calorie foods because

this patient doesn't want to eat so the

little bit that they do eat we want them

to be of high calorie uh value

serve food in Pleasant environment

why would you

put a plate of food for your patient and

right next to them

um is the emesis basin

there might be some sputum in there or

something right

so make sure it's a pleasant environment

so that patient will want to eat for

diarrhea you're going to encourage low

fiber right they don't need any more

fiber they've got diarrhea low fiber low

residue diet encourage fluid intake of

at least three liters per day because

with diarrhea that patient's losing

fluid and electrolytes that were in the

GI tract

we don't want that patient to be

dehydrated so we're going to encourage

fluids

constipation you're going to encourage

high fiber foods and increasing fluids

that fluid guys is going to help make

the stool not be as hard so the patient

can pass the stool easier

increase activity you know that moving

around walking that increase in activity

increases the peristalsis in the GI

tract

how about leukopenia

leuko type what do you think of Luke

when you hear leuko like leukocyte type

of WBC Pena a little bit of so what are

we going to do for that we're going to

obviously monitor the WBC count report

any temperature elevation because

remember guys those leukocytes which is

a type of WBC they help fight off

infection if this patient's wbcs are low

their leukocytes are low they're at risk

for infection infections so the first

hint of infections such as fever redness

out of sight inflammation any sign of

symptom of infection we're going to

report immediately so you're going to

report temperature elevation and any

other manifestation of infection teach a

patient to avoid large crowds and people

with infections this person

excuse me it's already immunocompromised

you think they need to go on a crowded

bus or Subway or concert absolutely not

we want to keep them safe and away from

infection

thrombocytopenia thromboclat cytal cell

penny a little bit of this patient has a

little bit of platelets which puts them

at risk for

um hemorrhaging

or bleeding so we're going to observe

the side for signs of bleeding such as

petechiae echymosis we're going to

monitor the platelet count

integumentary system alopecia

we're going to suggest ways to cope with

hair loss such as hair pieces scarves

wigs let me explain something about this

because this is shown up on Eclipse

enough times for me to mention that so

when it comes to this guys

you want to help the patient pick out a

wig before they start chemo radiation

all right and what you do is before they

start you want to help them pick out a

wig that is closest to their hair color

closest to their hair structure their

hair type

why because it's not when their hair is

thinning and brittle and falling out

that's when they're looking for a way

because most likely they're already

going to be depressed as it is so you

want to help the patient choose that wig

before they start preferably okay

cut long hair before therapy

not when they're getting therapy and

they're seeing that hair become dry and

brittle and fall out

okay lastly cognitive changes

where the CNS is involved that's known

as the chemo brain

you're going to teach the patient to use

a detailed planner because they may

forget things so you're going to teach

them to use a very detailed planner to

exercise their brain play word games

they can play word games on their phone

puzzles do things to exercise their

brains focus on one thing don't try to

try to Mo I can't speak don't try to

multitask focus on one thing at a time

and that will help with what's known as

a chemo brain all right let's go back to

the patient I was on

foreign

nursing implementation important nursing

interventions include one maximizing the

patient's physical functioning we want

that patient to move around as much as

possible we want that patient to do as

much for themselves as possible remember

one of our goals is always going to be

patient Independence

two teach patients that the acute side

effects of treatment are usually

temporary and you have to tell them that

because they will go into a depression

if they don't know that it's usually

temporary and three encourage patients

to discuss their quality of life issues

now while you can make these decisions

for yourself and you can speak for

yourself what would you like in the case

of that that you become incapacitating

you cannot make those decisions

the needs of the patient

with leukemia are best met by an

inter-professional team

psychiatrist oncology clinical nurse

specialist case manager dietitians a

chaplain social worker

let's talk about this for a minute

obviously the psychiatrist because as I

said guys this is a very

pervasive disorder okay and lots of

patients who have to have of this

disease or they go through chemo

radiation it causes some sort of

depression okay so we want to have

psychiatry in on it of course oncology

that's a cancer nurse on it case manager

case manager make sure that the ball

isn't dropped

um during transfers or the patient's

leaving that acute care facility and

they're going to rehab or they're going

to home they're going to make sure that

there's home health or you know just

make sure that everybody's on board so

there's no Gap in care

dietitian and that's very important

especially guys this patient

um is going to be on a special diet

chaplained to meet those spiritual needs

social workers to help that patient find

resources in the community specific

specifically if there are Financial

deficits maybe the patient you know

because this is a very expensive disease

to have chemo irradiation is not cheap

so there may be some Financial

constraints that the social worker can

help the patient and the family with

the life-threatening results of bone

marrow suppression again how many times

have we seen this guy's neutropenia

thrombocytopenia and anemia require

aggressive nursing interventions

teach a patient caregiver about the

importance of continued diligence in

disease management and the need for

follow-up care and guys that's her

leukemia in a nutshell much easier than

you thought right I know it was if you

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