2. Acute lymphocytic leukemia
(ALL) is a primary disorder of the
bone marrow in which the normal
marrow elements are replaced by
immature or undifferentiated
blast cells.
3. A. Acute lymphocytic leukemia
(ALL)
Null cell variety –having o cellular
surface markers and 80% belongs to
this type.
T cell variety – high risk type
B cell variety – high risk type
4. B. Acute non-lymphocytic leukemia
(ANLL)
C. Chronic lymphocytic leukemia (CLL)
– rare in children
D. Chronic myelocytic leukemia (CML)
Adult type
Juvenile type (congenital leukemia)
8. Supportive Therapy - To control
disease complications such as
hyperuricemia, infection, anemia,
bleeding, and pain.
Specific Therapy - To eradicate
malignant cells and to restore
normal marrow function.
9. Chemotherapy is used to achieve
complete remission, with restoration of
normal peripheral blood and physical
findings; administered through
indwelling central catheter or
implantable port.
10. 1. Induction
initial course-to achieve a complete
remission
combination of vincristine (Oncovin)
and prednisone
Third drug, such as 6-
mercaptopurine, doxorubicin or
cytosine
11. 2. CNS prophylaxis – It includes
Intrathecal administration of methotrexate
(Mexate) alone or in combination with
hydrocortisone (Cortef) and cytarabine.
3. Consolidation treatment – It
includes a combination of methotrexate, 6-
mercaptopurine, teniposide, etoposide,
cytosine arabinoside, cyclophosphamide,
prednisone, vincristine
12. 4. Maintenance or continuation
therapy –
It prevents reappearance of the disease.
It includes 6-mercaptopurine p/o Daily &
methotrexate p/o or I/M Daily
Intermittent administration of other drugs,
such as vincristine, prednisone, and
cyclophosphamide.
13. 5. Re-induction therapy - Induces remissions
if relapse occurs and usually includes the
same initial drugs.
6. If testicular relapse occurs, radiation
therapy to the testicles is administered.
7. Bone marrow transplantation.
14. Infection most frequently occurs in the blood,
lungs, GI tract, or skin. Patients with central
lines are at increased risk.
Haemorrhage usually caused by
thrombocytopenia.
CNS involvement.
Bony involvement.
Testicular involvement.
Urate nephropathy (rarely seen except in
induction).
15. Anxiety of parents related to learning of
diagnosis
Risk for Infection and hemorrhage related
to bone marrow suppression caused by
chemotherapy and disease
Disturbed Body Image related to alopecia
associated with chemotherapy
16. Acute Pain related to diagnostic procedures,
progression of the disease, and adverse
effects of treatment
Activity Intolerance related to fatigue that
results from the disease and treatment
Anxiety of child related to hospitalization
and diagnostic and treatment procedures
17. Imbalanced Nutrition: Less Than Body
Requirements related to anemia, anorexia,
nausea, vomiting, and mucosal ulceration
secondary to chemotherapy or radiation
18. 1. Decreasing Parental Anxiety
Be available to the parents when they want to
discuss their feelings.
Offer kindness, concern, consideration, and
sincerity toward the child and parents; be a
source of consolation.
Obtain the services of a social worker, as
appropriate, to help the family use appropriate
community resources.
19. Offer hope that therapy will be effective and
will prolong life.
Encourage parents to participate in
activities of daily living to help them feel a
part of their child's care.
Assess family dynamics and coping
mechanisms and plan interventions
accordingly.
Help the parents to deal with anticipatory
grief.
20. Encourage the parents to discuss concerns
about limiting their child's activities,
protecting child from infection, disciplining
child, and having anxieties about the
illness.
Facilitate communication with the clinic
nurse or clinical specialist who may interact
with the child during the entire course of
illness.
21. 2. Preventing Infection and
Hemorrhage
Monitor complete blood count (CBC) as
ordered.
Provide adequate hydration.
Observe renal function carefully.
Protect the child from infection sources.
Administer I.V. antibiotics as ordered.
Record vital signs and report changes
that may indicate hemorrhage.
22. Move and turn the child gently because
hemarthrosis may occur and may cause pain.
Avoid I.M. injections if possible.
Handle catheters and drainage and suction
tubes carefully to prevent mucosal bleeding.
Protect the child from injury by monitoring
activities and environmental hazards.
Be aware of emergency procedures for control
of bleeding.
23. 3. Promoting Optimal Nutrition
Provide a highly nutritious diet as tolerated
by the child.
Give careful oral hygiene
Be alert for nausea and vomiting.
24. 4. Community and Home Care
Considerations
Begin to develop a home care plan before
the child leaves the hospital.
Communicate with health care provider,
hospital nurses, family, and others familiar
with the case to gather information about
the child's illness, treatment plan, and
specific needs in the home.
25. Contact the child's school and arrange a
meeting with the school nurse, principal, and
appropriate teachers
Collaborate with primary care provider
regarding immunization schedule
26. 5. Family Education and Health
Maintenance
Teach parents about normal CBC values and
expected variations caused by therapy.
Instruct parents about leukemia and adverse
effects of chemotherapy.
Tell parents to call the health care provider if
child has a fever more than 101° F (38.3° C),
bleeding, signs of infections etc.
27. Teach parents the importance of detecting and
reporting fever in the child with leukemia. A fever
over 101° F may indicate overwhelming infection
and impending septic shock.
Teach preventive measures, such as hand
washing and isolation from children with
communicable diseases.
Reinforce that parents never use a rectal
thermometer.
