A client with chronic myelogenous leukemia (CML) has been diagnosed with terminal blast crisis. Which of the following clinical manifestations should the nurse focus the assessment on for this client? Select all that apply

Question

A) Shortness of breath and progressive dyspnea
B) Low temperature of 96°F
C) Headache and lethargy
D) Increasing confusion
E) Bleeding from the gums

Answer 1

Ans: A, C, D
Feedback:
The terminal blast crisis phase of CML represents evolution to acute leukemia and is characterized by an increasing number of myeloid precursors, especially blast cells, in the blood. With very high blast counts (>100,000 cells/mL), symptoms of leukostasis may occur. The high number of circulating leukemic blasts increases blood viscosity and predisposes to the development of leukoblastic emboli with obstruction of small blood vessels in the pulmonary and cerebral circulations. Occlusion of the pulmonary vessels leads to vessel rupture and infiltration of lung tissue, resulting in sudden shortness of breath and progressive dyspnea. Cerebral leukostasis leads to diffuse headache and lethargy, which can progress to confusion and coma.