Page 88 nursing.elitecme.com Complete Your CE Test Online - Click Here acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). Without treatment the disease is fatal . Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis of 67 years. It is a malignant disease of the bone marrow in which blood cells are halted in an early stage of development. These individuals may present with lab values related to bone marrow failure which causes anemia, neutropenia and thrombocytopenia. Fever may also be present. Hepatomegaly and splenomegaly may also be noted, along with pallor [9,13]. Chronic lymphocytic leukemia Chronic lymphocytic leukemia (CLL) is a progressive disease that is mainly a disease of older adults. CLL accounts for 25% to 40% of all leukemias . The disease is characterized by uncontrollable spread of abnormal lymphocytes in blood, bone marrow, and lymphoid tissue. Almost all patients diagnosed with CLL are over the age of 50 . Typical symptoms include fever, fatigue, malaise, and lymph node enlargement. As the disease reaches advanced stages, fatigue, weight loss, bone pain, and liver or spleen enlargement become apparent. Treatment consists of chemotherapy and radiation. Curiously, early treatment is not associated with increased survival. Thus, treatment is not initiated in older persons until they manifest weight loss, night sweats, fever, or enlarged lymph nodes [9,13]. EBP alert! The five-year survival rate for patients affected by CLL is about 50%. In fact, 25% to 30% of older adults with CLL live ten or more years . Thus it is important for nurses to encourage patients to do everything they can to adhere to treatment regimens and maintain a healthy lifestyle. Lymphomas Hodgkin’s Disease is a malignancy of the lymphoid tissue characterized by painless, progressive enlargement of lymph nodes, spleen and other lymphoid tissues. This disease is most common in young adults, but its incidence peaks in two age groups: persons who are between 15 and 35 years; and people over 50 years old . It is believed that there is a connection with the development of Hodgkin’s Disease and infection with the Epstein-Barr virus. Risk factors include a family history of infectious mononucleosis and a compromised immune system . Symptoms include painlessly enlarged lymph nodes, persistent fever, night sweats, fatigue, weight loss, pruritus, and anemia. The disease is treated with radiation, chemotherapy, or both, depending on the stage of the disease. Older adults usually receive chemotherapy for six to eight months [9,13]. Non-Hodgkin’s Lymphoma is a malignancy of lymphoid tissue that is more systemic in nature than Hodgkin’s Disease; the prognosis is usually poorer. Normal lymphoid tissues are replaced by cancerous cells. This compromises the immune system and leads to infections [9,13]. The first symptoms of the disease are usually swelling of the lymph glands, enlarged tonsils and adenoids, and painless, rubbery nodes in the cervical supraclavicular areas. Fatigue, malaise, weight loss, fever, and night sweats may also be present . Both types of lymphoma may be curable depending on the stage of the malignancy and with radiation and aggressive chemotherapy. However, older adults may not be able to tolerate such intense treatment. As aging continues, the older adult may need assistance with activities of daily living as s/he undergoes treatment for the disease, which may take six months or longer . Nursing consideration: Infection can have serious, even fatal consequences for patients with lymphomas. Patients should be taught to take every precaution to avoid infection. They should avoid crowds and family members or friends who are ill. Even those ill with minor infections such as colds should not come into contact with the patient. The nervous system The nervous system consists of the central nervous system and the peripheral nervous system. The central nervous system consists of the brain and the spinal cord and their main responsibility is the integration of all nervous system activities [9,53]. The brain is made up of the cerebrum, the brain stem, the cerebellum, the limbic system, and the reticular activating system (RAS) . The cerebrum contains the nerve center that controls intelligence, and motor and sensory function. The brain stem serves as the relay center for messages between the various parts of the nervous system. The cerebellum is responsible for maintaining muscle control, balance, and coordination. The limbic system initiates basic human drives such as hunger, emotional and sexual arousal, and aggression. The RAS assesses all incoming sensory information and sends it to the appropriate areas of the brain for interpretation. It is also imperative for maintaining consciousness [9,14]. The brain is divided into the right and left hemispheres, which are further divided into four lobes which are the frontal, temporal, parietal, and occipital lobes . It is important to know the functions of the various lobes since damage to one or more locations affect various body system functions [9,14]: ● ● The frontal lobe is responsible for personality, judgment, abstract reasoning, some aspects of language (Broca’s area), motor function, problem solving, reasoning, and memory. ● ● The temporal lobe is responsible for language comprehension (Wernicke’s area), some memory recall, and hearing. ● ● The parietal lobe integrates sensory information such as temperature and taste. It also interprets, size, shape, texture, and distance. ● ● The occipital lobe interprets visual stimuli. The spinal cord extends from the first cervical vertebrae to the lower border of the first lumbar vertebrae. The spinal cord is the major pathway for messages that travel back and for the between the brain and the body’s peripheral areas . The peripheral nervous system is composed of the cranial nerves, spinal nerves, the somatic and autonomic nervous system, and the reflex arc. There are 12 pairs of cranial nerves that transmit motor and/or sensory communications between the brain or brain stem and the head and neck . There are 31 pairs of spinal nerves that transmit messages to and from various regions of the body [9,14]. The somatic nervous system functions as the “link” between the brain via the spinal cord to muscles and sensory receptors. The autonomic nervous system is responsible for maintaining homeostasis . It can be a challenge to differentiate between normal aging changes of the central nervous system and pathology. The impact of aging on the nervous system varies quite a bit among older adults. Experts recommend that healthcare professionals “not treat normal aging changes as disease. A common myth is that cognitive decline is inevitable” . There are some age-related changes in memory and attention, but older adults retain the ability to learn new things and live independently as long as neurological disease/pathologies do not occur . Nursing consideration: Although it is important not to treat normal aging changes as disease, it is equally important not to delay assessment and treatment for disease because signs and symptoms were thought to be “normal” aging changes . Careful assessment and evaluation is important so that prompt diagnosis is made and appropriate treatment is initiated as indicated for neurologic conditions. Here are some normal age-related changes of the nervous system [9,14,53]: ● ● Decrease in size and weight of the brain. ● ● Decrease in number of neurons in conjunction with a decrease in the ability of neurons to grow branches of axons and dendrites leading to a decrease in synapses. ● ● Decrease in short-term memory. ● ● Decrease in cerebral blood flow and altered autoregulation of perfusion. ● ● Decrease in coordination. ● ● Decrease in the number and functioning of sensory neurons. ● ● Decrease or absence of deep tendon reflexes. ● ● Decrease responses and movements.