Leukemia
What is it?
Most common form of cancer in children, accounting for about one-third of all pediatric cases. It is a cancer of the blood and bone marrow, which affects the production of white blood cells. The exact cause of leukemia is unknown, but it is believed to involve a combination of genetic and environmental factors. Prognosis depends on age, initial WBC count, type of cell involved, and sex of child. More common in boys. Girls have a better survival rate.
Acute Lymphocytic Leukemia
Nursing Assessment
Common sites of infection are the skin, the respiratory tract, and the gastrointestinal tract. Monitor for fever.
Infection
Monitor for brain and spinal column involvement. Monitor for signs and symptoms of ↑ intracranial pressure.
Brain involvement
Look for clincal manifestations that indicate invasion of kidneys, reproductive organs, GI tract, and lungs.
Invasion of leukemic cells
Protection from Infection
- Neutropenic/Reverse Isolation
- Handwashing
- Aseptic technique
- No raw fruits or vegetables
- Only well-done meat
- No fresh flowers
- Bathe with antimicrobial soap
- Assess vital signs for signs of infection
- Assess urine for infection
- Assess mucous membranes
- Auscultate lung sounds
- Avoid invasive procedures: foleys, injections, and rectal temperatures
- No live vaccines (measles, mumps, rubella, and polio)
- Administer G-CSF granulocyte colony-stimulating factor as prescribed (Filgrastim). It makes bone marrow produce WBCs.
Bleeding Precautions
- Assess for signs and symptoms of bleeding (swelling, ecchymosis, petechiae)
- Handle child gently
- Measure abdominal girth (internal bleeding)
- Soft toothbrush and no dental flossing
- No injections
- Firm gentle pressure to bleeding sites x 10 minutes
- Avoid constrictive or tight clothing
- Avoid blowing nose
- Examine bodily fluids for blood
- Teach parents/child on signs and symptoms of bleeding
- Avoid NSAIDs, aspirin, and blood thinners.
Chemotherapy
- Monitor for severe bone marrow suppression (greatest risk for infection/bleeding/severe anemia).
- Chemotherapy drugs can be caustic (burn the skin). Prevent infiltration. Addressing a beeping IV pump is priority
- Monitor for infection and bleeding
- Prevent constipation (stool softeners)
- Monitor for nausea and vomiting
- Give antiemetics before chemotherapy
- Monitor for dehydration
- Monitor for mucositisÂ
- Monitor for neuropathy
- Monitor kidney function (chemotherapy drugs may affect kidneys)
- Inform parents/child that hair loss may occur but hair regrows in 3 to 6 months with slightly different texture.
- Encourage verbalization of feelings
Specific Side Effects
- Vincristine: Peripheral neuropathy
- Daunorubicin/Doxorubicin: Cardiomyopathy
- Methotrexate: Renal damage and GI irritation
