Leukemia: Pathophysiology, Signs, Treatment and Nursing

Abstract

The purpose of this paper is to discuss a disease it its entirety. In this essay, the student’s chosen disease was leukemia. The idea is to explore all aspects of the disease. Topics such as pathophysiology, signs, symptoms, treatments, nursing interventions, and discharge teachings will be discussed. All sources will be referenced. Pertinent information will be discussed, and potential research breakthroughs will also be referenced.

Leukemia Essay

Leukemia is a cancer of blood-forming tissues that has ruined the lives of many children. According to the American Cancer Society, leukemia is the most prevalent cancer in children and teens (American Cancer Society, n.d.). It accounts for nearly 1 out of 3 cancers in children and teens (American cancer Society, n.d.). Over the years research has reached key milestones in the treatment of leukemia. The pathophysiology, signs, symptoms, and treatments for leukemia have been well defined over the years. Nursing interventions and teachings have also been well defined. As nurses it is imperative that care of children with leukemia is done with utmost caution.

Pathophysiology

  What is leukemia?  Leukemia is a cancer of blood forming tissues (Huether, McCance, Brashers, & Rote, 2017).  An example of a blood forming tissue is bone marrow. There are several types of leukemia, however acute lymphoblastic leukemia (ALL) is the most common form in children. (Ricci, Kyle, Carman, 2017).  The basic idea behind ALL is that there is an overproduction of lymphoblasts that immature. The lymphoblasts do not function as fully mature lymphocytes. Due to the overproduction of lymphoblasts, normal functioning white blood cells are replaced. This is not the only issue as the massive amount of production of lymphoblasts requires a higher rate of metabolic need (Ricci, Kyle, Carman, 2017). The other cells of the body are starved of nutrients in order to meet the metabolic need of the overproduction of lymphoblasts (Ricci, Kyle, Carman, 2017). As one might imagine this rerouting of the body's resources can lead to growth delays in children. It also interferes with the production of red blood cells, white blood cells, and platelets (Ricci, Kyle, Carman, 2017). This can lead to anemia and increased susceptibility to infection. The other form of leukemia that is common in children is known as acute myeloid leukemia (AML). This form leukemia affects myeloid cells, otherwise known as precursor cells. The core concept of this form of leukemia is that there is an accumulation of these myeloid blasts in organs and the bone marrow itself (Huether, McCance, Brashers, & Rote, 2017). 

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 There is not a clear understanding of what exactly causes leukemia, but there have been factors that have been identified that may predispose one to leukemia. According to one journal article there are certain conditions that predispose someone to ALL specifically. These include: Down syndrome, ionizing radiation, pesticides, Epstein-Barr Virus and Human Immunodeficiency Virus (Abdul-Hay, & Terwilliger. 2017). None of these studies have been particularly conclusive on what is the definitive cause of leukemia.

Signs and Symptoms

 There are a variety of different signs and symptoms to leukemia. For ALL signs and symptoms will present as: fever, recurrent infection, fatigue, pallor, bleeding, bruising, abdominal pain, nausea, vomiting, bone pain and headache. (Ricci, Kyle, Carman, 2017). AML signs and symptoms include popular lesions, visual disturbances, headache, increased intracranial pressure, nausea, and vomiting. (Ricci, Kyle, Carman, 2017).  A diagnostic test to look at is the hemoglobin level. According toUnderstanding Pathophysiology, a textbook which explains the pathophysiology of many diseases, 45% of all children with leukemia will have a hemoglobin level under 7 g/dL. (Huether, McCance, Brashers, & Rote, 2017).  Another important manifestation is possible renal failure. In ALL renal failure results from hyperuricemia. (Huether, McCance, Brashers, & Rote, 2017).

 There are many diagnostic tests that exist that can help determine if someone has leukemia. While the observable signs may indicate leukemia, the diagnostic tests can definitively diagnose this disease. As stated, earlier values such as uric acid levels or hemoglobin can be accomplished through retrieving labs. Things like a complete blood count could show that someone has leukemia. More specifically, tests that can help diagnose leukemia include CBC, Peripheral blood smears, bone marrow aspiration, lumbar punctures, liver function tests, and chest radiography (Ricci, Kyle, Carman, 2017).  All these tests can help either diagnose leukemia or help determine where the leukemia has spread.

Treatment

 There are a variety of medical treatments available for leukemia. The main treatment for ALL is chemotherapy. It is divided into three separate stages. The first stage of chemotherapy is known as induction. It is a three to four-week period where treatment is aggressive and rapid to cause complete remission of the disease (Ricci, Kyle, Carman, 2017).  The second stage of treatment is consolidation or intensification. This stage revolves around strengthening remission and reducing the leukemic cells. (Ricci, Kyle, Carman, 2017).    The final stage is known as maintenance. This is where the elimination of residual leukemic cells over a two to three-year period. (Ricci, Kyle, Carman, 2017). During this entire process treatment is given to prevent potential central nervous system disease. This is a major complication of leukemia as it can spread to the central nervous system. This treatment is known as CNS prophylaxis. In this treatment, intrathecal chemotherapy and cranial radiation are given periodically in order to prevent leukemia to spread to the central nervous system (Ricci, Kyle, Carman, 2017).

 For the AML variant of leukemia, there are other treatments available aside from chemotherapy. According to the American Cancer Society progress on AML research has reached a point where new treatments exist for AML (American Cancer Society 2018). These include: Stem cell transplants, specialized targeted drugs, and immune therapy (American Cancer Society, 2018). As a note chemotherapy is still the main treatment for AML, but these are alternative therapies that could be a supplementary treatment.  

Nursing Intervention

 The management of a patient with leukemia revolves around many different factors. The nurse’s role in caring for a child with leukemia includes, infection control, pain management, anemia, bleeding, the effects of hyperuricemia, and others. (Ricci, Kyle, Carman, 2017).  As a person with leukemia has reduced immunity, infection control is imperative. The interventions for infection control can include maintaining aseptic technique, hand washing, isolation precautions, and to vaccinate the child (Ricci, Kyle, Carman, 2017). These are all things that can be done to maintain infection control.  Another important aspect to treatment of someone with leukemia is proper nutrition. The strain of chemotherapy can cause significant nausea and a loss of appetite; thus, intervention is necessary. Antiemetics may be necessary to assist in the nausea. For nutrition, things like offering small frequent meals, finding out the child’s food preferences, offering high calorie snacks, supplementation, or total parenteral nutrition can assist (Ricci, Kyle, Carman, 2017).  If total parenteral nutrition is ordered, infection control becomes even more important than it already was. Pain management is necessary because the treatment and the disease can cause significant pain (Ricci, Kyle, Carman, 2017). Some distraction techniques can be used depending on the child’s developmental level. Music, television, TV, or games can be used as distractions (Ricci, Kyle, Carman, 2017).  As far as medication goes, analgesics like acetaminophen can be used for acute pain (Ricci, Kyle, Carman, 2017). For severe pain, narcotics can be administered as ordered (Ricci, Kyle, Carman, 2017). Overall there is a lot of different things a nurse must be prepared for when caring for someone with leukemia. If treatment is mismanaged it can lead to significant issues.

Discharge Teachings

Educating families as they leave the hospital with their children is imperative. There are a variety of things the parent and child must know before they can safely go home. Education on things such as medication regimens are of utmost importance. Knowing the signs of infection could also save the child’s life. One teaching is to watch for fever in the home. Fever must be reported immediately so that antibiotic therapy can begin immediately (Ricci, Kyle, Carman, 2017). Education on proper nutrition is also important as well. The nursing interventions mentioned earlier about small frequent meals or high calorie snacks are things that can also be applied to discharge teachings. The nurse can also educate on various foods and supplements the child should have. For example, iron rich foods are important for children that are experiencing anemia due to leukemia (Ricci, Kyle, Carman, 2017). One food to avoid is cow’s milk which can lead to iron deficiencies (Ricci, Kyle, Carman, 2017).   The nurse can also teach the parents regarding distractions if the child is in pain related to their disease. In fact, many of the nursing interventions can be applied to teaching.

Conclusion

Leukemia is not something to be trifled with. It can ruin someone’s life relatively insidiously. It develops in the young and vulnerable which is quite sad. Luckily, treatment of this disease has progressed to a point where people can live comfortably, and more treatments are being researched. Nurses must be cognizant of as many things as possible to keep the child safe and protected when caring for their leukemia

References

• American Cancer Society (21 August 2018). What’s new in acute myeloid leukemia (AML) research?. Retrieved from: cancer.org/cancer/acute-myeloid-leukemia/about/new-research.html
• American Cancer Society (n.d.) Leukemia in children. Retrieved from: https://www.cancer.org/cancer/leukemia-in-children.html
• Huether, S. E., McCance, K. L., Brashers V. L., & Rote, N. S. Understanding pathophysiology. St. Louis, MO: Elsevier Inc.
• Ricci, S.S., Carman, S., & Kyle, T. (2017). Maternity and pediatric nursing. Philadelphia, PA: Wolters Kluwer.
• Terwilliger, T., Abdul-Hay, M. (30 June 2017). Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood cancer J. 7, 577. DOI: https://doi.org/10.1038/bcj.2017.53