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chemicals, including previous chemotherapy for other cancers. There's also a chance of AML progressingfrom other
blood diseases and chronic leukemias, such as chronic myelogenous leukemia, myelodysplasiaor other disorders in
which the bone marrow produces too much of certain types of blood cells(myeloproliferative disorders).
RISK FACTORS
The risk of acute myelogenous leukemia increases with age. It's most prevalent in people in their 60s
and older. The disorder is also more common in males than in females. Other possible risk factors include:
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People who've had certain types of chemotherapy and radiation therapy or
treatment for childhood acute lymphocytic leukemia (ALL) may have a greater risk of developing
AML.
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People exposed to very high levels of radiation,
such as survivors of an atomic bomb blast or a nuclear reactor accident, have an increased risk ofdeveloping AML.
Exposure to certain chemicals, such as benzene ² which is found in unleadedgasoline and used by the chemical
industry ² also is linked to greater risk of AML.
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AML is linked to cigarette smoke, which contains benzene and other known cancer-
causing chemicals. Smokers older than 60 face twice the risk of AML that nonsmokers do.
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People who've had another blood disorder, such as myelodysplasia,
polycythemia vera or thrombocythemia, are at greater risk of developing AML.
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Certain genetic disorders, such as Down syndrome, are associated with an
increased risk of AML.
 




è Care Guide in Patient with disease Conditionc
TREATMENT
Treatment of patients withacute myelogenous leukemia depends onage and the subtype of the
disease. In general, treatment falls into two phases:
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The purpose of the first phase of treatment is to kill the leukemia
cells in your blood and bone marrow. However, remission induction usually doesn't wipe out all of
the leukemia cells, so you need further treatment to prevent the disease from returning.
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Also called post-remission therapy, maintenance therapy or intensification,
this phase of treatment is aimed at destroying the remaining leukemia cells. It's considered crucial to
decreasing the risk of relapse.
Therapies used in these phases include:
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Chemotherapy is the major form of remission induction therapy. A common
course of therapy involves two chemotherapy drugs ² cytarabine (Cytosar-U), followed by ananthracycline drug,
such as daunorubicin (Cerubidine) or idarubicin (Idamycin). A third medication,thioguanine, is sometimes used.
If you have AML, you'll probably stay in the hospital during the treatment cycle because thechemotherapy destroys
many normal blood cells in the process of killing leukemia cells. Thischemotherapy can cause anemia, infection and
bleeding. If the first cycle of treatment doesn't causeremission, you may need it repeated one or two more times.
Other drug combinations also may beused, depending on your specific situation.
Chemotherapy can also be used for consolidation therapy. This phase may include a combination ofdifferent
medications that mimic the induction, but usually includes high doses of cytarabine byitself for one to three cycles.
Dour doctor may also prescribe medications that boost white cellproduction to reduce the risk of infection. These
medications are called granulocyte colonystimulating factors (Neupogen, Leukine).

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Arsenic trioxide and all-trans retinoic acid (ATRA) are anti-cancer drugs that
can be used alone ² or in combination with chemotherapy ² for remission induction of a certainsubtype of AML
called promyelocytic leukemia. These drugs cause leukemia cells with a specificgene mutation to mature and die, or
to stop dividing.
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Also known as immunotherapy, biological therapy uses substances that bolster
your immune system's response to cancer. Monoclonal antibodies are one form of biologicaltherapy. These
antibodies are produced in a laboratory, but they mimic protein products found inyour immune system (antibodies)
that attack foreign substances (antigens) on leukemic cells.Gemtuzumab ozogamicin (Mylotarg) is a monoclonal
antibody linked to a chemical toxin thatattaches to AML cells. It's used to treat older people with AML who don't
respond to initialtreatment or who relapse after successful initial treatment. Researchers are testing its
effectivenessin younger people with AML.
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This is another option for consolidation therapy for people at high risk
of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia tore-establish
healthy stem cells by replacing their leukemic bone marrow with leukemia-freemarrow. If you choose this treatment,
you'll receive very high doses of chemotherapy or radiationtherapy to destroy your leukemia-producing bone
marrow. This marrow is then replaced by bonemarrow from a compatible donor (allogeneic transplant). In some
cases, you may also be able to useyour own bone marrow for transplant (autologous transplant). This is possible if
you go intoremission and then save healthy bone marrow for a future transplant.
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Stem cell transplant is also used for consolidation therapy. It's similar to bone
marrow transplant except the stem cells are collected from circulating blood (peripheral blood),rather than from the
bone marrow, thanks to a medication that causes larger numbers of stem cellsto be released from the bone marrow.
The cells used for transplant can be your own healthy cells, orthey can be collected from a compatible donor. This
procedure is used more frequently than bonemarrow transplant because of shortened recovery times and possible
decreased risk of leukemiarecurrence.
  
 
Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors.
For AML, external radiation therapy is used.Inc
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 radiation is directed at thetumor from a
source outside the body. This type of treatment is used for AML that has spread²ormay spread²to the brain and
spinal cord. It can also be used to treat bone pain that comes frombone affected by the leukemia.
NCP
3- ³ masakit lahat sakin lalo na lalamunan ko´ as verbalized by the patient
 w eaknes s

-feeling of exhaustion

-low RBC counts: 1.93

- low hemoglobin count: 6.77

-shortness of breath
 -fatigue

-blood pressure: 100/60 mmhg

M Activity Intolerance: fatigue related to anemia
 demonstrate a decrease in physiologic signs of intolerance
 plan care with rest periods between activities
elevate head of bed as tolerated
provide positive atmosphere, while acknowledging difficulty of the situation of the patient

provide quiet environment, maintain bed rest as indicated. Limit visitors, phone calls and reported

unplanned interruptions

prioritize nursing care schedules to enhance rest.

use energy techniques such as shower chair, sitting performing task

provide assistance with patient, including activities that the patient views as essential.
Increase
activity levels as tolerated
instruct patient to stop activity if palpitations, chest pains, shortness of breath, weakness, dizziness
occur
change patient position slowly and monitor for dizziness
0 the patient shows a decrease signs of intolerance

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Early detection of an ailment is vital to the patient.Oftentimes lack of in-depth knowledgeregarding a
condition of a disease may hinder a patient in seeking immediate advice from medicalspecialist. Fear and financial
problems may sometimes interfere which may often lead to the severity of thedisease.This I believe is one of the
major causes as to why my patient has gone to this terminal stage of his
Acute Myelogenous Leukemia (AML). The nature of his job as a painter exposes him to great risk of anorgan
damage. Petroleum products when exposed to a person to a considerable period of time may oftenlead a person to
this problem. This is also coupled with lack of knowledge regarding this health hazard.
According to his recent laboratory results, his platelet is 27,000 /cu mm which is very lowcompared to the
normal platelet count of 150,000-450,000/ cu mm. This shows a decrease in both plateletsand erythrocytes. The
patient shows hematuria, melena and petechiae on his both upper and lowerextremities, this is an indication of
decrease in platelet as well. Because of lack of mature and normalgranulocytes, the patient had a massive tonsillitis.
Since treatment for chemotherapy is too costly for thepatient this could contribute for a compelling severity of his
health condition.
It is necessary to undertake sessions of chemotherapy to prolong the patient¶s life. Immaturity
ofleukocytes can also lead to severe infection, the patient is encouraged to wear mask whenever the
conditionnecessitates. The patient needs proper rest due to fatigue. He also needs more encouragement from
hisimmediate family member, relatives and friends.
Government sector plays a great role in sustaining financial support for indigent patients. Healthcare
institutions can also help in the financial assistance of their members. Advancement of medicaltechnology and
profession is always a mileage in the science of medical world.