Pediatric - Oncological Disorders - Nursing Study Notes

ATLAND Nursing
Pediatric Oncological Disorders
Nursing Study Notes

1. Leukemia
Overview
It is the malignancy of the stem cells (myeloid and lymphoid) in the bone marrow and lymphatic
system characterized by the proliferation of white blood cells and their precursors.

Proliferated cells depress the bone marrow resulting in anemia, neutropenia, and
thrombocytopenia.

Risk Factors

 Genetics
 Viral infections
 Environmental factors
 Exposure to radiations
 Chemicals
 Some drugs

Two major types of leukemia common in the pediatric population are:

 Acute lymphocytic/lymphoblastic leukemia
Characterized by proliferation and accumulation of immature granulocytes in the bone
marrow which may infiltrate the central nervous system. Commonly affects children, and
accounts for 80% of childhood leukemia
 Acute Myelogenous/ myelocytic leukemia
Characterized by uncontrolled proliferation and accumulation of myeloblasts in the bone
marrow. Accounts for 20% of childhood leukemia.

Acute leukemia has a short clinical course, rapid onset, and progression which can result in
death in days or months if left untreated.




ATLAND Nursing 1 Pediatric Nursing Study Notes

,Leukemia is treated using intrathecal chemotherapeutic agents and radiation therapy reserved
for leukemia involving CNS disease or testicular relapse. The three major phases in the
management of leukemia include

 Induction; achieves a complete remission
 Intensification or consolidation; further reduces the tumor burden
 Maintenance; Further chemotherapy to ensure the disease remains in remission.

Assessment




Fig 1: Clinical Features of Leukemia

Diagnostic Tests
 Based on the assessment data
 Complete blood count demonstrates;
o Normal, increased, or decreased white blood cells,
o Low hematocrit and low hemoglobin levels.



ATLAND Nursing 2 Pediatric Nursing Study Notes

,  Bone marrow biopsy and aspiration (definitive tests) reveal 80% to 90% immature blast
cells.
 Lumbar puncture performed to determine CNS involvement.
 Peripheral blood smear demonstrates low blood counts and immature leukocytes.

Interventions
 Reverse isolation to prevent infections.
 Administer antiemetic drugs as prescribed before chemotherapy.
 Monitor for the side effects of chemotherapy agents (dehydration, peripheral neuropathy,
hemorrhagic cystitis, nausea, vomiting, and altered bowel function)
 Provide care towards the management of the side effects caused by chemotherapeutic
agents.
 Monitor for severe bone marrow suppression.
 Administer stool softeners as prescribed to prevent straining in case of constipation.
 Provide rectal hygiene gently to prevent bleeding.
 Instruct the child and the parent on the signs and symptoms to watch out during
chemotherapy and inform the primary healthcare provider.
 Inform the parents and the child that chemotherapy can cause alopecia.
 Inform the parents that hair loss due to chemotherapy may regrow within 3 to 6 months
but will be slightly different in color and texture.
 Evaluate the effectiveness of the therapy and interventions by monitoring laboratory
results.
 Prepare the patient for bone marrow transplant if indicated.
 Assist and plan the child’s activities allowing adequate rest periods during care to
prevent fatigue.
 Provide the child with meals that don’t irritate the oral mucosa, and require little chewing.
 Parenteral or enteral feeding as prescribed if the child cannot feed orally to provide
nutrition.
 Administer packed red blood cells transfusion as prescribed for a child with severe blood
loss.
 Administer platelet transfusion as prescribed to a patient with active bleeding episodes
that occur during the induction or relapse therapy and are unresponsive to local
treatment.
 Provide emotional support to the child and the family

ATLAND Nursing 3 Pediatric Nursing Study Notes