It is a malignant neoplasm involving all blood forming organs and causing an over production of any type of WBC.
During childhood acute leukemia is the commonest form.
The onset may be rapid or gradual, wide spread petechiae,the child is pale and has anorexia,vomiting,weight loss, weakness and fatiuge.The temperature is elevated. The child bleeds easily and a slight bruises result in a large ecchymotic area.
Responsibility of the nurse:
The nursing care of a child having leukemia is based not only on the sign,symptom,complication of the disease it self but also on the side effect of the drug used in the treatment.
- Protection from infection and treatment of any infection.
- Since the child who has leukemia also has anemia, he gets tired easily and need frequent rest period. He should have well balanced meals, an adequate fluid intake is important.
- Since the child has low platelet count he should be observed carefully for hemorrhage.
- Good oral hygiene is important.
- The child is observed carefully for any indication of CNS involvement such as changes in his behavior,nausea,vomiting,irritability and headache.
- The child must be observed for convulsion and any toxic manifestation of the drug used.
- Bone marrow aspirate is necessary for diagnosis and treatment of leukemia. Bone marrow is obtained from the sternum or iliac crest.
- The child must be given physical and emotional support.
- When the critically ill child lapse into unconsciousness, the nurse must remain with the parents at his bed side so that they know that every thing possible is being done for his comfort.
Treatment of leukemia:
- Supportive treatment: includes the administration of blood,antibiotics,sedative may also be given to make the child comfortable.
- Chemotherapy: specific therapy involves the use of chemotherapeutic agents(cytotoxic drugs) which produce certain side effects when used.
- Corticosteroids:produce Cushing’s syndrome including moon face, fluid retention,hypertention,personality changes when heavy dose or prolong therapy is given.
- Methotrexate:it’s use also produce sign of toxicity including oral and gastrointestinal ulceration,hemorrhage,chills,fever,hematologic depression, skin reaction such as rash,acne,diarrhoea and occasionally alopecia may also be seen.
- 6-Mercaptopurine:-The chief manifestation of toxicity of this drug are interference with hematopoiesis and myelotoxicity.
- Vincristine:The drug may produce sensory and neuromuscular toxicity as well as constipation and alopecia.
- Cyclophosphamide:May produce nausea,vomiting,anorexia,depression of bone marrow,myelotoxicity,asterile hematologic cystitis and alopecia may also occur.
- Daunorubicin:It’s use cause bone marrow damage and complication involving the cardiopulmonary system, gastrointestinal disturbance, skin rash and hair loss.
- L-asparginase:The toxic effect include potentially dangerous blood coagulation and liver tissue abnormality, allergic reaction of the anaphylactic type may occur.
- Cytosar:The predominant toxic effect is marrow suppression and may also produce nausea and vomiting.