Development and Assessment of Leukemia in Adults

Leukemia is a particular term used to describe cancers of the blood. Leukemia happens from the aberrant reproduction of mature lymphocyte and myeloid cells. There are four types of leukemia. These leukemias are known as Chronic lymphoblastic leukemia (CLL), Chronic myelogenous leukemia (CML), Acute lymphoblastic leukemia (ALL) and Acute myelogenous leukemia (AML). Acute leukemia presents as the most common blood cancer in the United States. ALL and AML are most commonly diagnosed in the adult population. As the research progresses, it is necessary for nurses to stay current with evidence-based research while caring for patients who are dealing with Acute myelogenous leukemia. The purpose of this paper is to use evidence-based research to assist nurses and interdisciplinary teams in the diagnosis, treatment and education of patients with AML specifically (Bryant, Walton, Shaw-Kokot, Mayer, & Reeve, 2015).

Nursing Assessment Data

There are some vital assessments that the nurse should conduct when seeing a patient who may have AML. The nurse should perform a comprehensive assessment which includes all body systems. The nurse should obtain a height and weight for the patient, noting any report of weight loss. Assessing for nausea and anorexia can lead to weight loss. Assess temperature for fever. This could be an indication of infection due to a deficient production of lymphocytes (Medlineplus.gov, 2018). Assess the blood pressure and heart rate for increase as a sign of pain. Auscultate the heart for tachycardia and a murmur. This would indicate cardiac compensation. Auscultate the lungs for dyspnea, rhonchi, crackles or a decrease in lung sounds. Also, check for weakness and pallor. These may be signs of anemia from an absence of red blood cell production (Medlineplus.gov, 2018). Assess the skin for bruises and petechiae distributed over arms and the trunk of the body. This may be a sign of inadequate platelet production. Assess the mucous membranes for redness or bleeding. Because of platelet nonfunction, bleeding times will be extended. Assess for muscle weakness and reports of generalized fatigue. This would be due to the body’s inability to carry oxygen to other cells in the body for energy production. CBC should be drawn, and the nurse should monitor for an elevated WBC count (Medlineplus.gov, 2018).

Age, Gender and Genetic Makeup

According to the American Cancer Society, AML can occur at any age. As a person ages the chances of getting AML becomes more common. People who are over the age of 55 are more likely to get AML. The median age for diagnosis for all types of leukemia is age 66 (Cancer.gov, 2019). About half of adults diagnosed with AML are past the age of 65 at the time of their diagnosis (Cancer.net, 2019). Acute leukemia is more frequently diagnosed in men than women. This occurrence is not one that is understood. Gender differences can have an effect on the adjustment to cancer. During treatment, women are more likely to be a part of the decision-making process than men. Women also desire more emotional support during treatment. Men tend to take on more of a passive attitude. Men desire more medical information than females do (Lester, Stout, Crosthwaite & Andersen 2017). Even though familial connections to acute leukemia are rare, there is an inherited vulnerability to hematopoietic neoplasms. AML includes the germline mutation CEBPA. Germline ANKRD26, GATA2 and RUNX1 are also included. Acute leukemia risks increase in those who have inherited a bone marrow failure syndrome. A family history that has a first or second degree relative that has AML or ALL, an immunodeficiency, a blood cancer cell, a persistent state of thrombocytopenia or prone to bleeding form a very young age are important pieces of evidence for acute leukemia with a germline origin. Other factors include prior radiation therapy or exposure as an associated risk, especially for AML. Being exposed to particular chemicals has an increased risk for the development of AML. Exposure to high levels of Benzene increases the risk of developing AML (Arber, Borowitz, Cessna, Etzell, Foucar, Hasserjian, & Vardiman, 2017). Genetic disorders like Down syndrome, Diamond-Blackfan syndrome, Fanconi’s anemia and Shwachman syndrome are linked to a higher incidence of AML (lls.org, 2011).

Cultural, Ethical and Psychosocial Aspects

Nurses make an ethical decision every day to take care of patients based on their own moral values. Many people who are dealing with AML have been diagnosed at a later age in life. The emotional impact of being diagnosed with AML may escalate quickly after ones’ diagnosis. This type of cancer is not biased to one particular race or culture. Nurses have to remain cognizant of how the patient is feeling throughout all phases of care and adjust as best they can to accommodate the patients’ physical as well as psychosocial needs. According to the article by Bala-Hampton et al, “Economic distress as a result of a cancer diagnosis might be considered comparable to physical symptomology (such as depression, anxiety, panic, and social isolation) and can be disabling as any significant variable that should be studied in guiding cancer management.” Even though men are more likely to be diagnosed with AML, women require more emotional support. Nurses have to make the appropriate adjustments in order to provide the best possible care. Social factors of health such as race, education, and income are associated with less than positive outcomes. These factors can equate to late diagnosis, delays in treatment or an inability to obtain care or complete care that has been started (Bala-Hampton, Dudjak, Albrecht, & Rosenzweig, 2017)

Evidence Based Practice in Nursing Practice

The evidence-based practice article used for this paper had a focus on patient’s self-reported distress during and after going through induction therapy. The article discussed survivors experience of moderate to severe distress that does not decrease from their initial diagnosis through their survivorship of acute leukemia. Survivors reported notable anxiety after their diagnosis along with treatment. Being able to manage physical and psychological distress is crucial to circumvent an alteration in the patient’s quality of life. Nurses must be aware of their institutions’ defined plan for a patient showing signs of distress. Cancer recurrence has an association with prolonged or noncontrolled distress. When the nurse can better understand the patient’s nature and level of distress in the beginning of the survivorship course, this can clarify the appropriate interventions in which to use to improve their health outcome (Lester, Stout, Crosthwaite & Andersen 2017).

The article also takes focus on distress and psychological issues which happen in leukemia subtypes. Persistent side effects along with difficulties stemming from comorbid conditions, decrease in social support, psychological anxiety, continuous functional disabilities and notable fatigue occur with patients. Patient’s who have AML were seen to have the most deficient psychological outcomes to that of survivors who had other types of leukemia. Identifying continuous distress and symptoms as early as possible will produce favorable interventions that target and increase patient outcomes (Lester et al, 2017). Nurses must understand the implications in order to administer treatments, handle side effects, educate their patients and give support through the continuity of care. Interventions should be outlined to assist patients in moving beyond the distress. Interventions that help increase effective coping mechanisms are critical to increase adjustment and the patients’ well-being.

Health Promotion and Recovery

An important area the nurse can educate the patient on is survivorship. Survivorship focuses on personalized care which is established on the patient’s need to boost their health, improvement and belief that leads them toward managing their health and well-being. The nurse can teach them to take care of comorbidities and educate them on cancer rehabilitation by providing a treatment summary. Patients need to also prepare for the impact of a possible relapse and side effects of treatment to include physical and psychological aspects (Leukemia.org.uk, 2018).

Loft (2013) notes that with an increasing population of survivorship, nurses have the opportunity to interact with survivors to give them support and information throughout their journey. By educating the patient, nurses assist them to make informed choices about their present and future health status. Risk factors should be discussed with those patients who may need referrals to additional resources. Nurses can help patient’s by giving them information about healthy lifestyles and cancer screenings. Nurses can begin conversations about changing lifestyle behaviors, provide information, provide resources, and give referrals. Nurses need to be familiar with resources that are available in order to assist survivors in meeting their needs.

Community Resources

According to the Leukemia and Lymphoma Society’s website, there is a local chapter in Columbia, SC. The patient can go to the website www.lls.org/south-carolina. This website has a section labeled support resources, where they offer services such as, information specialists, patient community, support groups and peer-to-peer support. Additional support resources include financial support, food and nutrition, LLS podcast, online chats, caregiver support and other helpful organizations. A patient can also go to their office located at 107 Westpark Blvd. Ste 150 Columbia, SC 29210. Another website the nurse can refer the patient to is the American Cancer Society. The web address is www.cancer.org/about-us/local/south-carolina.html. The local office for Columbia is located at 200 Center Point Circle, Ste. 100 Columbia, SC 29210. Services offered include transportation, cancer information, and lodging. There are two hospitals within the community that also offer support group programs. They are Prisma Health and Lexington Medical Center. The patient can go to their websites for information. The nurse should offer this information to the patient, because once the patient realizes there is additional support available, they will be able to better manage their treatment and recovery.

Conclusion

Acute Myelogenous Leukemia (AML) is commonly diagnosed in older adults. Comprehensive assessment is vital to the diagnosis and subsequent treatment of AML. This is valuable in helping the patient obtain the best possible outcomes. Educating the patient is an extremely important aspect of treatment for the nurse. By educating the patient on areas such as survivorship and lowering psychological distress, the nurse can help to empower the patient in the management of their own health and well-being.