University of Perpetual Help System

Dr. Jose G. Tamayo Medical University

Sto. Niño, Biñan Laguna

MIDTERM
BSN IV - B
 In a person with leukemia, the bone marrow
makes abnormal WBC. The abnormal cells
are leukemia cells.

 Unlike normal blood cells, leukemia cells

don’t die when they should. They may crowd
out normal WBC, RBC and platelets. This
makes it hard for normal blood cells to do
their work.
 Acute:
 Leukemia cells can’t do any of the work of
normal WBC.
 Number of leukemia cell increase RAPIDLY.
 Usually worsen quickly.
 Chronic:
 Early in disease, leukemia cells can still do some
of the work of normal WBC.
 Patient may not have any symptoms at first.
 SLOWLY chronic leukemia gets worse.
 As the number of leukemia cells in the blood,
more people get symptoms such as swollen
lymph nodes or infection.
 When symptoms do appear, they are usually
mild at first and get worse gradually.
 Smoking – Cigarettes increase the risk of
acute myeloid leukemia.
 (myeloid is common in adult. Cause: Prenatal
exposure)
 Benzene: Used widely in the chemical
industry. It’s found in cigarettes.
 Radiation – Atomic bomb, explosions (such
as those in Japan during world war II) people,
especially children, who survive atomic bomb
explosions are the high risk of leukemia.

 Radiation Therapy – Diagnostic x-rays:

Dental x-rays and other diagnostic x-rays
(such as CT scan) exposure of people to much
lower levels of radiation.
 Chemotherapy: Example – Alkylating agents or
topoisomerase inhibitor is linked with a small
chance of later developing acute leukemia.
 Down Syndrome: Certain other inherited
disease.
 Myelodysplastic syndrome and certain other
blood disorders:
 HUMAN T-CELL LEUKEMIA virus TYPE 1 (HTLV
– I)
 Exposure to electromagnetic fields (?)
 Acute Lymphocytic: About 80% of
incidence; BETTER prognosis than for
myelogenous.

 Acute myelogenous or acute non-

lymphoid: About 10% incidence: POORER
prognosis.

 Other: 5% incidence.
 Hairy Cell Leukemia:
 Unsual type of chronic leukemia.
 Development of “SPIKY” WBC that behave
aggresively.

 Chronic Lymphocytic Leukemia:

 Chronic lymphoblastic leukemia.
 Most affected are people over 55y/o.
 Children are almost never affected.
 Chronic Myeloid Leukemia:
 Chronic myelogenous leukemia.
 It affects mainly adults.
 Anemia – Pallor, weakness, irritability.
 Infection: Fever
 Tendency towards bleeding: PETECHIAE and
bleeding into joints.
 Pain in joints caused by seepage of serous
fluid.
 Tendency toward early fracture of bones.
 Enlargement of spleen, liver, lymph glands.
 Abdominal pain and anorexia resulting in
weight loss.
 Necrosis and bleeding of gums and other
mucous membrane.
 Later symptoms: CNS involvement and frank
hemorrhage.
 Physical Exam
 Blood test
 Leukocytosis
 Elevated Lap score
 Biopsy
 Bone marrow aspiration
 Cytogenetics
 Spinal tap
 Chest radiography
 Other imaging studies (MRI, computed
tomography)
 Site :
 Sternum vertebral body
 Iliac crest
 Tibia of infants

 Performed to study the cells involved in blood

production.
 Chemotherapy
 Biological therapy – interferon
 Radiation therapy
 Stem cell transplant
 Monoclonal antibody injections (For CLL)
 Interferon injections (For CML)

Radiation
• Damages cells by destroying the genetic
material that controls how cells grow and
divide. 
 They are characterized by the ability to
renew themselves through mitotic cell
division and differentiate into a diverse range
of specialized cell types.
 Bone marrow transplantation
 Peripheral stem cell transplantation
 Umbilical cord blood transplantation
 Autologous stem blood transplantation
 Syngeneic stem blood transplantation
 Method of replacing blood-forming cells
destroyed by cancer treatment.
 Immature blood cells (stem cells) in the
circulating blood.
 Transplantation may be autologous (an
individual’s own blood cell saved earlier).
 Allogeneic – blood cells donated by someone
else.
 Syngeneic – blood cells donated by identical
twin.
 Myelosuppression
 Alopecia
 Mouth and lip sore, nausea, vomiting,
constipation or diarrhea
 Infertility
 Rashes or swelling at injection site
 Easy fatigability
 Graft versus host disease
COLORECTAL
 Sigmoid colon is the most common site
 Predominantly adenocarcinoma
 If early diag→ 90% Survival
 34% diag. early
 66% late diag.
 Colorectal area is the 3rd most common site of
new cancer cases and death.

 Incidence increases with age and is higher for

people with a family history of colon cancer
and those with IBD (inflammatory bowel
disease) or polyps.
 Increasing age
 Family history
 Previous colon CA or polyps
 History of infected bowel disease (Crohn’s
disease or ulcerative colitis)
 High fat, high protein, low fiber
 Link with breast cancer and gynecologic
malignancies / genital cancer.
 Predominantly (95%) adrenocarcinoma

 Usually starts as a benign polyp but may

become malignant, invade and destroy
normal tissues, and extent into surrounding
structure
 Cancer cells may break away from the
primary tumor and spread to other parts of
the body (most often the liver)
 Polyps associated with colon cancer:
 Adenomas
 Hyperplastic polyps
 Inflammatory polyps
 Determined by the location of the cancer, the
stage of the disease, and the function of the
intestinal segment in which it is located.
 Change in bowel habits.
 Passage of blood in the stools.
 Unexplained anemia, anorexia, weight loss,
and fatigue.
 SCYBALOUS STOOLS.
 Tenesmus, rectal pain, feeling of incomplete
evacuation after a bowel movement, alternating
diarrhea and constipation and bloody stool
(rectal lesions).
 Dull abdominal pain and melena (Right colon).

 Abdominal pain, cramping, narrowing stools,

constipation and distention (Left colon).
 Hematochezia or melena.
• Imaging studies
→ Plain abdominal radiograpy
→ Abdominal computed tomograpy
• Fecalysis with occult blood determination
• Direct visualization with biopsy
→ Proctosigmoidoscopy
Colonoscopy
• Tumor Marker
→ Carcinoembryonic Antigen (CEA)
 STAGES
Stage 0 - Earliest stage of colon cancer.
- Confined only to lining or the mucosa
of the colon or polyps.
Stage I - The polyp has evolved into a tumor.
- There is extension beyond the
mucosa.
Stage II - Extension beyond the colon.
- There is no local node metastasis.
Stage III - Extension beyond the colon with
involvement of the local nodes.
Stage IV - Distant metastasis.
Recurrent Tumor - Tumor has recurred or reappeared
after completion of treatment and
complete remission.
 Depends on the stage of the disease
 Surgery to remove the tumor
 Supportive therapy
 Adjuvant therapy
 Chemotherapy
 Radiation therapy
 Immunotherapy
 Multimodality therapy - is the use of two or more
methods of treatment. Ex: Chemo and Radia.therapy
 Surgery is the primary treatment.
 Based on location and tumor size.
 Cancers limited to one site can be removed
through the coloscope.
 LOCAL EXCISION –
 Done when colon cancer is diagnosed at an
early stage.
 Not as invasive as other surgical
interventions, may be done through
colonoscopy.
 RESECTION –
 Performed when the lesion is large.
 Open surgery is done with partial colectomy
and regional lymph node dissection for
staging.
 RESECTION & COLOSTOMY –
 Larger tumors may be removed en bloc.
 Ends of normal colon may not be
anastomosed anymore and a colostomy is
done.
 RADIOFREQUENCY ABLATION –
 Uses a special probe with electrodes that
directly ablate or destroy cancer cell.
 May be done percutaneously or through an
abdominal incision under general
anaesthesia.
 CRYOSURGERY –
 Also called “Cryotherapy”
 Uses an instrument that freezes and destroys
carcinoma in situ.
 Chemotherapy
 Uses methotrexate and fluouracil
 May be done as primary treatment

NURSING INTERVENTION:
Pre-operative care:
~ Provide high protein, high calories and low residue
diet.
~ Provide information about post-op care and stoma
care.
~ Administer antibiotics 1 day prior.
~ Enema or colonic irrigation the evening and morning
of surgery.
~ NGT is inserted to prevent distention.
~ Monitor UO, F and E, abdominal PE.
Post-operative care:
~ Monitor for complication.
~ Leakage from the site, prolapse of stoma, skin
irritation and pulmonary complication.
~ Asses the abdomen for return of peristalsis.
~ Asses wound dressing for bleeding.
~ Assists patient in ambulation after 24hours
~ Provide nutritional teaching.
- Limit food that cause gas-forming and odor.
- Cabbage, beans, eggs, fish, peanuts.
- Low-fiber diet in the early stage of recovery.
- Instruct to splint the incision & administer pain
medication before exercise.
~ Stoma is PINKISH to cherry red, slightly edematous
with minimal pinkish drainage.
~ Manage post-operation complication.
• NURSING INTERVENTION: COLOSTOMY CARE
• Begins to function 3-6days after surgery.
• Drainage may be soft / mushy or semi-solid
depending on the site.
• Best time to do skin care is after shower.
• Apply tape to the side of the pouch before shower.
 Assume a sitting or steady position in changing
the pouch.
 Instruct to gently push the skin down and the
pouch pulling up.
 Wash the peristomal area with soap and water.
 Cover the stoma while wasting the peristomal
area.
 Lightly pad dry the area and never rub.
 Lightly dust the peristomal area with nystatin
powder.
 Measure the stomal opening.
 Empty the pouch or change the pouch when:
 1/3 to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
 COMPLICATION:
 Partial / complete bowel obstruction
 Hemorrhage
 Perforation
 Abcess formation
 Peristonitis
 Sepsis and shock