Primary Nursing Diagnosis

Risk for infection related to decreased primary and secondary responses

OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Nutrition status; Treatment behavior: Illness or injury; Hydration; Knowledge: Infection control

INTERVENTIONS. Infection control; Infection protection; Surveillance; Fluid/electrolyte management; Medication management; Temperature regulation

U PLANNING AND IMPLEMENTATION Collaborative

The treatment for acute leukemia occurs in four phases: induction, consolidation, continuation, and treatment of (CNS) leukemia. During the induction phase, the patient receives an intense course of chemotherapy that is meant to cause a complete remission of the disease. Complete remission occurs when the patient has less than 5% of the bone marrow cells as blast cells and the peripheral blood counts are normal. Once remission has been sustained for 1 month, the patient enters the consolidation phase, during which she or he receives a modified course of chemotherapy to eradicate any remaining disease. The continuation, or maintenance, phase may continue for more than a year, during which time the patient receives small doses of chemotherapy every 3 to 4 weeks. Treatment of CNS leukemia is an essential component of therapy that has replaced irradiation, which leads to significant CNS complications, with intensive intrathecal and systemic chemotherapy for most patients.

Some patients also need transfusions with blood component therapy to control infection and prevent bleeding and anemia. Bone marrow transplantation (BMT) is an option for some patients. Early BMTs were allogenic transplants using stem cells that had been harvested from bone marrow from siblings or matched from unrelated relatives. In autologous BMTs in the 1980s, physicians began using frozen cells harvested from the donor's own marrow during remission. More recently, a newer form of transplant has occurred with peripheral blood stem cell transplant (SCT)

566 Leukemia, Acute or peripheral blood progenitor cell transplant. Multiple pheresis, or removal of cells from the blood, provides the stem cells from the patient for transplantation. SCT permits the use of doses of chemotherapy and radiation therapy high enough to destroy the patient's bone marrow; after the treatment is completed SCT restores blood-producing bone marrow stem cells. Radiation treatment is sometimes used to treat leukemic cells in the brain, spinal cord, or testicles.

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