Concept about Leukemia – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.
Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.
Concept about Leukemia
Definition of Leukemia:
It is a disease of abnormal proliferation and maturation of bone marrow which interferes with the production of normal RBCs, WBCs and platelets.
(Ref: Paediatric Nursing, Parul Datta/3/329)
[OTHER DEFINITIONS – NICE TO KNOW]
These are malignant disorders of the haemopoietic stem cell compartment, characteristically associated with increased numbers of white cells in the bone marrow and/ or peripheral blood.
(Ref-Davidson-1035/22)
Leukemia are the disease in which abnormal proliferation of haemopoietic cells cause progressively increasing infiltration of the bone marrow and other tissues such as lymphnode, liver & spleen. That means, malignant neoplasm of haemopoietic cell is called Leukaemia.
Classification of Leukemia:
| Clinical classification: | A. According to Clinical course of disease: a) Acute b) Chronic B. According to Types & degree of differentiation of the cell population or cell line predominantly involved. a) Myeloid b) Lymphoid. It may be explained as – Acute leukaemia:
Chronic Leukemia:
|
| FAB classification: (French,American,British): | A. Acute lymphobastic leukaemia (ALL): a) L1-small homogenous lymphoblast b) L2-heterogenous lymphoblast c) L3-large homogenous lymphoblast B. Acute myeloblastic leukaemia (AML): a) MO Myeloblastic leukaemia with minimal differentiation b) Ml-Myeloblastic leukaemia without maturation c) M2-Myeloblastic leukaemia with maturation d) M3-Hypergranular promyelocytic leukaemia e) M4-Myelomonocytic leukaemia f) M5-Monocytic leukaemia g) M6-Eroythrocytic leukaemia h) M7- Megakaryoblastic leukaemia |
WHO Classification Of Acute Leukemia:
- Acute myeloblastic leukaemia with recurrent genetic abnormalities.
- Acute myeloblastic leukaemia with multilineage dysplasia
- Acute myeloblastic leukaemia & myelodysplastic syndrome
- Acute myeloblastic leukaemia not otherwise specified
Acute lymphobastic leukaemia.
(Ref-Davidson-1036/22)
Etiology of Leukemia:
A. Chromosomal abnormalities.
B. Ionizing radiation –
- X-ray radiation
- Radiotherapy
- Atom bomb.
C. Chemicals:
- Cytotoxic drugs
- Benzene
D. Virus-
- HTLV-1 (human T cell lymphotrophic virus type-1)
E. Genetic factor-
- Identical twin of patient with leukemia.
- Down syndrome.
- Blooms syndrome
- Fanconi’s anaemias
F. Immunological:
- Immune deficiency states (e.g. hypogammaglobulinaemia)
(Ref. de Gruchy’s 206-09/6)
Clinical Features of Acute Leukemia:
A. Symptoms:
a) Feature of anaemia:
- Weakness, fatigue, lassitude, effort intolerance, dyspnoea on exertion.
- Pallor, palpitation, anorexia
b) Feature of leucopenia:
- Fever
- Malaise
- Sore throat
- Ulceration of mouth & pharynx
- Chills
- Sweating
- Chronic skin infection
- Recurrent chest infection.
- Pneumonia, diarrhoea, UTI, otitis media, cellulitis.
c) Feature of thrombocytopenia (Mainly by purpuric spot):
- Ecchymosis
- Patechiae
- Epistaxis
- Bleeding from gum, alimentary tract,
- Sub-conjunctival hge, fundal hge, haematemesis, maelenat
- Menorrhagia
- Hematuria.
- Joint swelling & joint pain, bone pain.
d) General-Fatigue, wt loss, bone pain cough. Headache or diaphoresis.
B. Signs:
a) Appearance-toxic & ill looking.
b) Anaemia-Present
c) Pulse-rapid.
d) Temp-raised.
e) Lymph node – moderately enlarged, non-tender, discrete, tree from skin & underlying structure.
f) Bony tenderness.
g) Skin (Evidence of bleeding) – Ecchymosis. purpura & Patechiac
h) Testicular enlargement.
(Ref-Kumar & Clark-468/7th +de Gruchy’s 242/5th+Davidson’s 1036-37/22)
Clinical Features of Chronic Leukemia:
Symptoms:
- Asymptomatic (25%).
- Shortness of breath due to anaemia
- Abdominal pain & discomfort
- Tiredness, fatigue, pale, lethargy
- Wt. loss
- Fever & night sweat
- Anorexia, nausea, vomiting.
- Headache due to hyperleukocytosis
- Brusing & bleeding episode (Terminal stage).
Signs:
- Anaemia – early
- Spleenomegaly – huge (90%)
- Hepatomegaly (50%)
- Bony tenderness- present
- A friction rub in splenic infarction.
- Lymphadenopathy unusual.
- Retinal hge due to leukocytosis
Treatment of Acute Leukemia:
A. Specific Rx: Chemotherapy: Only 2 phases
| 1. Phase 1 (Remission induction) |
|
| 2. Phase 2 (Remission consolidation) |
|
B. Supportive Rx:
- Correction of anemia: Fresh blood transfusion, packed cell transfusion.
- Correction of bleeding
- Broad spectrum antibiotic
- Maintenance of fluid and electrolyte balance
- Monitoring of renal and hepatic function
- Psychological support
- Alternative chemotherapy – Hydrourea and mercaptopurine
- Curative Rx: Bone marrow transplantation
Nursing Management/ Intervention of Leukemia:
1. Providing emotional support to the parent to reduce parental anxiety. Encouraging the parents to express their feeling and answering their questions honestly.
2. Necessary information and instructions to be given to the parents and family members to avail support services, community resources and religious help to adjust with the stress situation.
3. Preventing infections and hemorrhage. The following measures to be followed:
- Maintaining aseptic technique, hygienic measures, general cleanliness, good hand- washing practices, restriction of visitors and taking precautions during any invasive procedures.
- Administering antibiotics; as prescribed. Oral and IV route to be used. Intramuscular injection should be best avoided.
- Precautions to be taken during blood transfusion.
- Avoiding injury. Soft toothbrush can be used for dental care. Soft jelly to be applied for dry lips. Nonirritating mouth wash to be used, no alcohol to be used. Breaking of skin and mucous membrane to be avoided.
- Monitoring vital signs, urinary output, hydration level, signs of infections, bleeding or any other complications.
4. Relieving pain by rest, comfort, minimizing exertion, promoting relaxation and diversion and administering prescribed analgesics.
5. Maintaining normal body temperature by tepid sponge in high feve4 airy environment, adequate fluid intake, avoiding overclothing and hot environment, administering antipyretics and other prescribed drugs.
6. Recording vital signs 4 hourly. Avoiding use of rectal thermometer.
7. Promoting adequate nutritional intake with high nutritious diet with small frequent feed.
8. Avoiding high salty food, when steroids are given.
9. Anti-emetics to be given to prevent vomiting.
10. Diet should be attractive and tasty to promote intake of more amount.
11. Explaining about the change of body image, especially in case of alopecia due to chemotherapy.
(Ref: Paediatric Nursing, Parul Datta/34/332)
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