Acute Lymphoblastic Leukemia

Question 1

ALL is the most common form of cancer in children

Answer 1

TRUE

Question 2

Pathophysiology of Acute Lymphoblastic Leukemia

Answer 2

1. The exact cause of ALL remains unknown
2. Abnormal lymphoblastic abound in the blood-forming tissues. The growth of lymphoblastic is excessive and the abnormal cells replace the normal cells in the bone marrow
3. The bone marrow becomes unable to maintain normal levels of RBC, WBCs and platelets, so anemia, neutropenia and thrombocytopenia results.

Question 3

Therapeutic Management

Answer 3

1. Focuses on giving chemotherapy to eradicate the leukemia cells and restore normal bone marrow function

Question 4

Signs and Symptoms

Answer 4

1. Fever
2. Fatigue, malaise, or listlessness
3. Pallor
4. Unusual bleeding or bruising
5. Abdominal Pain
6. Nausea and vomiting
7. Bone pain
8. Headache

Question 5

Risk Factors

Answer 5

1. Male gender
2. Age 2-5
3. Caucasian Race
4. Down Syndrome
5. Sibling with leukemia
6. Radiation exposure
7. Previous chemotherapy treatment

Question 6

Physical Examination

Answer 6

1. Take temperature (fever may be present)
2. Look for petechiae, purpura or unusual bleeding (due to decreased platelet count)
3. Inspect the skin for signs of infection
4. Auscultation the lungs, noting adventitious breath sound (may indicate pneumonia)
5. Note location and size of enlarged lymph nodes
6. Palpate liver and spleen for enlargement
7. Document tenderness on abdominal palpation

Question 7

Labs and Diagnostics

Answer 7

Labs:
1. Low hemoglobin and hematocrit
2. Decreased RBC count
3. Decreased Platelets
4. Elevated, normal or decreased WBC count

Diagnostics:
1. Lumbar Puncture
2. Bone marrow aspiration

Question 8

Nursing Management

Answer 8

• Focuses on managing disease complications such as: infection, pain, anemia, bleeding and hyperuricemia*

1. Many children require treatment for severe anemia or low platelet levels with active bleeding

Question 9

Nursing Management: Reducing Pain

Answer 9

1. Most common areas of pain are: head and neck, legs, and abdomen
2. Use distraction techniques such as listening to music, watching TV or playing games to help take the child’s mind off pain
3. Administer mild analgesics (acetaminophen) for acute pain episodes
4. Use EMLA cream prior to venipuncture, port access, lumbar puncture, and bone marrow aspiration
5. Apply heat or cold to the painful area
6. Administer narcotic analgesics for episodes of acute severe pain or for palliation of chronic pain