Nursing Diagnosis For Acute Lymphoblastic Leukemia

Lab Tests Used To Diagnose And Classify All

One or more of the following lab tests may be done on the samples to diagnose AML and/or to determine the specific subtype of ALL.

Routine exams with a microscope: The bone marrow samples are looked at with a microscope by a pathologist and may be reviewed by the patientâs hematologist/oncologist .

The doctors will look at the size, shape, and other traits of the white blood cells in the samples to classify them into specific types.

A key factor is whether the cells look mature , or immature . The most immature cells are called lymphoblasts .

Determining what percentage of cells in the bone marrow are blasts is particularly important. A diagnosis of ALL generally requires that at least 20% of the cells in the bone marrow are blasts. Under normal circumstances, blasts don’t make up more than 5% of bone marrow cells.

Sometimes just counting and looking at the cells doesnât provide a definite diagnosis, and other lab tests are needed.

Cytochemistry: In cytochemistry tests, cells are put on a slide and exposed to chemical stains that react only with some types of leukemia cells. These stains cause color changes that can be seen under a microscope, which can help the doctor determine what types of cells are present. For instance, one stain will turn parts of acute myeloid leukemia cells black, but has no effect on ALL cells.

For ALL, these tests are most often used to help determine the exact subtype of in someone already thought to have ALL based on other tests.

Treatment Of Recurrent All

If the ALL recurs during or after treatment, the child will most likely be treated again with chemotherapy. Much of the treatment strategy depends on how soon the leukemia returns after the first treatment. If the relapse occurs after a long time, the same drugs might still be effective, so the same or similar treatment may be used to try to get the leukemia into a second remission.

If it comes back after a shorter time interval, more aggressive chemo with other drugs may be needed. The most commonly used chemo drugs are vincristine, L-asparaginase, anthracyclines , cyclophosphamide, cytarabine , and either etoposide or teniposide. The child will also receive a steroid . Intrathecal chemo will also be given.

For children whose leukemia comes back sooner after starting treatment, or for children with T-cell ALL who relapse, a stem cell transplant may be considered, especially if the child has a brother or sister who is a good tissue type match. Stem cell transplants may also be used for children who relapse after a second course of chemotherapy.

Some children have an extramedullary relapse, meaning that leukemia cells are found in one part of the body but are not detectable in the bone marrow. In addition to intensive chemotherapy as described above, children with spread to the CSF may get more intense intrathecal chemotherapy, sometimes with radiation to the brain and spinal cord . Boys with relapse in a testicle may get radiation to the area.

Nanda Nursing Diagnosis And Interventions For Leukemia

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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Leukemia May Affect Red Blood Cells White Blood Cells And Platelets

In a healthy child, the bone marrow makes blood stem cells that become mature blood cells over time. A blood stem cell may become a myeloidstem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

• Platelets that form blood clots to stop bleeding.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes :

• B lymphocytes that make antibodies to help fight infection.
• T lymphocytes that help B lymphocytes make the antibodies that help fight infection.

In a child with ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called leukemia cells. These leukemia cells do not work like normal lymphocytes and are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.

This summary is about acute lymphoblastic leukemia in children, adolescents, and young adults. See the following PDQ summaries for information about other types of leukemia:

• Hairy Cell Leukemia Treatment

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Past Treatment For Cancer And Certain Genetic Conditions Affect The Risk Of Having Childhood All

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk.

Possible risk factors for ALL include the following:

• Being exposed to x-rays before birth.
• Being exposed to radiation.
• Constitutional mismatch repair deficiency .

Desired Outcomes/evaluation Criteriapatient Will:

• Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible.
• Use identified techniques to enhance activity tolerance.
• Participate willingly in necessary/desired activities.
• Report measurable increase in activity tolerance.
• Demonstrate a decrease in physiological signs of intolerance .
• Desired Outcomes/Evaluation

Desired outcomes/evaluation criteriapatient will:

• Participate in learning process.
• Identify interferences to learning and specific action to deal with them.
• Exhibit increased interest/assume responsibility for own learning by beginning to look for information and ask questions.
• Verbalize understanding of condition/disease process and treatment.
• Identify relationship of signs/symptoms to the disease process and correlate symptoms with causative factors.
• Perform necessary procedures correctly and explain reasons for the actions.
• Initiate necessary lifestyle changes and participate in treatment regimen.

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Treatment Of Children With Acute Lymphocytic Leukemia

The main treatment for children with acute lymphocytic leukemia is chemotherapy, which is usually given in 3 main phases:

• Induction
• Consolidation
• Maintenance

The entire length of treatment is typically about 2 to 3 years, with the most intense treatment in the first few months.

Children with ALL are typically classified by risk group to make sure that the correct types and doses of drugs are given. Treatment may be more or less intense, depending on the risk group.

Symptoms Caused By Low Numbers Of Blood Cells

Most signs and symptoms of ALL are the result of shortages of normal blood cells, which happen when the leukemia cells crowd out the normal blood-making cells in the bone marrow. These shortages show up on blood tests, but they can also cause symptoms, including:

• Feeling tired
• Infections that dont go away or keep coming back
• Bruises on the skin
• Bleeding, such as frequent or severe nosebleeds, bleeding gums, or heavy menstrual bleeding in women

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Assessment And Diagnostic Findings

The diagnosis of ALL can be confirmed with a combination of the following:

• Bone marrow aspiration. Typical clinical findings and bone marrow aspirate showing a proliferation of immature WBCs confirm ALL.
• Bone marrow biopsy. A bone marrow biopsy, usually of the posterior superior iliac spine, is part of the diagnostic workup.
• Blood counts. Blood counts show severe anemia, thrombocytopenia, and neutropenia.
• Differential leukocyte count. Differential leukocyte count determines cell type.
• Lumbar puncture. Lumbar puncture detects meningeal involvement.
• Uric acid levels.Elevated uric acid levels and lactic dehydrogenase levels are commonly found.

Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

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Risk Factors May Include

Msn Exam For Acute Leukemia *

MSN Exam for Acute Leukemia *

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Leukemia Nclex Review Care Plans

Nursing Study Guide on Leukemia

Leukemia is a medical condition that involves the cancer of the blood-forming tissues of the body, which include the bone marrow and the lymphatic system. It is a blood cancer that can be acute or chronic in nature.

Some types of leukemia are more commonly found in children, while other forms are usually seen in adults. Currently, there is no absolute cure for leukemia.

However, the treatment plans for leukemia are being rapidly developed in the past few decades. These have shown promising results in terms of the overall increase in survivorship and improvement of the quality of life for patients.

Certain Factors Affect Prognosis And Treatment Options

The prognosis depends on:

• How quickly and how low the leukemia cell count drops after the first month of treatment.
• Age at the time of diagnosis, sex, race, and ethnic background.
• The number of white blood cells in the blood at the time of diagnosis.
• Whether the leukemia cells began from B lymphocytes or T lymphocytes.
• Whether there are certain changes in the chromosomes or genes of the leukemia cells.
• Whether the child has Down syndrome.
• Whether leukemia cells are found in the cerebrospinal fluid.
• The child’s weight at the time of diagnosis and during treatment.

Treatment options depend on:

• Whether the leukemia cells began from B lymphocytes or T lymphocytes.
• Whether the child has standard-risk, high-risk, or very highrisk ALL.
• The age of the child at the time of diagnosis.
• Whether there are certain changes in the chromosomes of lymphocytes, such as the Philadelphia chromosome.
• Whether the child was treated with steroids before the start of induction therapy.
• How quickly and how low the leukemia cell count drops during treatment.

For leukemia that relapses after treatment, the prognosis and treatment options depend partly on the following:

• How long it is between the time of diagnosis and when the leukemia comes back.
• Whether the leukemia comes back in the bone marrow or in other parts of the body.

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Medical History And Physical Exam

If you have signs and symptoms that suggest you might have leukemia, the doctor will want to get a thorough medical history, including how long you have had symptoms and if you have possibly been exposed to anything considered a risk factor.

During the physical exam, the doctor will probably focus on any enlarged lymph nodes, areas of bleeding or bruising, or possible signs of infection. The eyes, mouth, and skin will be looked at carefully, and a thorough nervous system exam may be done. Your abdomen will be felt for spleen or liver enlargement.

If there is reason to think low levels of blood cells might be causing your symptoms , the doctor will most likely order blood tests to check your blood cell counts. You might also be referred to a hematologist, a doctor who specializes in diseases of the blood .

Signs And Symptoms Of Leukemia

Each type of leukemia may have varying signs and symptoms. Generally, leukemia patients have the following clinical manifestations:

• Swollen lymph nodes, enlarged liver or spleen
• Persistent fatigue
• Malaise or generalised body weakness
• Moderate to severe infections which may be recurrent
• Unexplained or unintentional weight loss
• Recurrent nosebleeds
• Tendency to bleed or bruise easily
• Petechiae tiny red spots on the skin
• Excessive sweating, especially at night

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Nursing Considerations For Adverse Events From Car T

Chimeric antigen receptor T-cell therapy offers options for pediatric patients with relapsed or refractory acute lymphoblastic leukemia, but it comes with a unique set of side effects that can range from mild to severe. As the primary patient providers, oncology nurses are often the first to identify signs and symptoms of adverse events and acute changes in patients status. Understanding what to watch for can improve outcomes and help nurses deliver safe, effective care.

In their article in the April 2017 issue of the Clinical Journal of Oncology Nursing, Smith and Venella discussed the oncology nursing interventions for inpatient management of moderate to severe toxicities from CAR T-cell therapy.

Nursing Diagnosis For Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia

• exposure to very high doses of radiation either accidentally or therapeutically
• exposure to industrial chemicals like benzene, pesticides and certain types of chemotherapy used to treat other cancers.

Signs and Symptoms

• High number of leukemia cells causes: Pain in the bones or joints, Lack of appetite, Headache, Vomiting.
• Low number of platelets causes: Cuts that heal slowly, Easy bruising or bleeding, Tiny red spots on the skin .
• Low number of white blood cells causes: Fever, Frequent infections, Infections that are hard to treat.
• Low number of red blood cells causes: Fatigue , Shortness of breath, Unusually pale skin.

Nursing Diagnosis for Acute Lymphoblastic Leukemia

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