i at ric

Ped ng By: Rexale R

ur s i i
a M. Pajado
N BSN 4AMT

1
 What is Leukemia?
0 Leukemia is cancer of the blood and develops in the
bone marrow.

0 It is a group of malignant diseases in which normal

bone marrow elements are replaced by abnormal
immature lymphocytes.

0 The term leukemia refers to cancers of the white

blood cells, which are also referred to as leukocytes
or WBCs.

2
 Who is affected by Leukemia?
0 Mostly children under 15 years old.

What causes leukemia in children?

0 acquired genetic diseases.
0 Factors such as exposure to:
0 certain viruses
0 environmental factors
0 chemical exposures
0 infections have been associated with
damage to the immune system.
3
 PATHOPHYSIOLOGY
A single lymphoid undergoes malignant transformation

In the bone marrow, there is “Crowding Out” of normal

RBC’s

oPancytopenia – marked reduction number in

RBC’s, WBC’s and platelets
oImmunosuppression
4
 Types of Leukemia
0 Acute lymphocytic leukemia (ALL)

0 Acute myelogenous leukemia

(AML)

0 Chronic myelogenous leukemia

(CML)
5
 Acute Lymphocytic Leukemia (ALL)

0 also called lymphoblastic or lymphoid, accounts for

most of the childhood leukemias
0 With acute lymphocytic leukemia, the bone marrow
makes too many of these lymphocytes and they do
not mature correctly.

0 Acute leukemia can occur over a short period of

days to weeks

0 Chromosome abnormalities (extra chromosomes

and structural changes in the chromosome material)
are present in the majority of ALL patients.
6
Clinical Manifestations
0 Fever
0 Bone and Joint pain
0 Paleness
0 Night sweats
0 Feeling weak or tired
0 Swollen glands (lymphadenopathy) in the neck,
under arms, and groin
0 Easy bruising and bleeding (bleeding gums, skin
bleeding, nosebleeds, menstrual irregularities)
0 Loss of appetite and weight loss
0 Pinpoint red spots on the skin (petechiae) 7
Acute Myelogenous Leukemia (AML)
0 Also called granulocytic, myelocytic, myeloblastic, or myeloid,
accounts for mostly the remainder of the childhood leukemias.

0 Acute myelogenous leukemia is a cancer of the blood in which too

many granulocytes, a type of white blood cell, are produced in the
marrow.

0 With acute myelogenous leukemia, the bone marrow makes too

many of these cells and they do not mature correctly.

0 Acute leukemia can occur over a short period of days to weeks.

0 Children with certain genetic syndromes, including Fanconi

anemia, Bloom syndrome, Kostmann syndrome, and Down
syndrome, are at a higher risk of developing AML.
8
Clinical Manifestations
0 Benign Symptoms resembling the flu
• fever • malaise
• fatigue • anorexia

0 Severe and life threatening

• bleeding
• Severe hemorrhage

0 Chloromas

0 Enlargement of the liver and spleen is often seen at

initial presentation
0 Significant lymphadenopathy occurs less often
9
 Chronic Myelogenous Leukemia (CML)
0 (CML) is uncommon in children

0 Chronic myelogenous leukemia is cancer of the blood in

which too many granulocytes, a type of white blood cell,
are produced in the marrow.
0 Chronic myelogenous leukemia can occur over a period
of months or years.
0 Part of chromosome #9 breaks off and attaches itself to
chromosome #22, so that there is an exchange of genetic
material between these two chromosomes. This
rearrangement changes the position and functions of certain
genes, which results in uncontrolled cell growth.
10
Clinical Manifestations
0 Fever
0 Frequent Infections
0 Night sweats
0 Feeling run – down or tired
0 Loss of appetite
0 Easy bruising and bleeding (bleeding gums, skin
bleeding, nosebleeds, menstrual irregularities)
0 Pain or fullness below the ribs on the left side
0 Pale skin

11
What causes Leukemia in children?
0 Both pre-natal and post-natal exposure to ionizing
radiation (particularly X rays) can cause leukemia in
children. 

0 Pesticides

0 Solvents

0 EMFs - Electric and Magnetic Fields

0 Radon

12
Diagnostic Tests
0 bone marrow aspiration and/or biopsy
0 Complete blood count (CBC)
• Additional blood tests - may include blood chemistries,
evaluation of liver and kidney functions, and genetic
studies.
0 computed tomography scan (CT or CAT scan)
0 magnetic resonance imaging (MRI)
0 x-ray
0 Ultrasound (Also called sonography)
0 lymph node biopsy
0 spinal tap/lumbar puncture
13
Treatment
0 chemotherapy
0 Intrathecal medications/chemotherapy
0 Bone marrow transplantation or peripheral blood stem
cell transplantation
0 Targeted therapy
0 Medications
• to prevent or treat damage to other systems of the
body caused by leukemia treatment
• for nausea and side effects of treatment
• to prevent/treat infections

0 blood transfusions
0 continuous follow-up care 14
 0 Biological therapy
0 Radition therapy

0 Stem cell transplant

Other therapy
0 Acupuncture
0 Coenzyme Q10
0 Polysaccharide K

Stages of Leukemia Treatment

0 Induction
0 intensification or consolidation
0 maintenance 15
Nursing Diagnosis
0 Risk for Infection related to neutropenia from the
disease process and treatment
0 Risk for Injury related to thrombocytopenia

0 Risk for Injury (renal) related to tumor lysis

0 Acute pain related to diagnosis, disease process and

treatment
0 Imbalance Nutrition: Less than body requirements related
to loss of appetite, nausea, vomiting, and mucositis

16
Nursing Interventions
0 Assess painful areas for location, severity and signs of
infections
0 Monitor vital signs frequently for signs of infection
and bleeding
0 Use meticulous handwashing techniques at all times
0 Use aseptic techniques for all invasive procedures
0 Avoid skin punctures when possible
0 Protect mucous membranes by using soft bristle or
sponge toothbrush to avoid trauma
0 Institute and teach safety precautions
0 Maintain IV hydration to induce urine
17
0 Administer medications
‽ Allopurinol
‽ Sodium bicarbonate
‽ Antiemetics
‽ Antibiotics and immunoglobulins
0 Administer antibiotics as ordered; monitor for expected
and toxic effects
0 Monitor Blood Urea Nitrogen (BUN), creatinine, electrolytes
and minerals
0 Venipunctures and procedures should be done in the
treatment room and not in the child’s room
0 Offer small amount of foods frequently throughout the day
18
0 Encourage high protein and high calorie foods
0 Make breakfast as high in caloric intake as possible
0 Avoid making food issue for power or control and
emphasize this to caregivers
0 Encourage caregivers to bring child’s favorite foods from
home
0 Provide mouth analgesics as ordered before food and fluid
intake

19
 CHEMOTHERAPEUTIC
DRUG DRUGSROUTE
CLASSIFICATION SIDE EFFECTS
Asparaginase Enzyme IM Hepatotoxicity,
Pancreatitis,
Allergic Reactions
Corticosteroids Corticosteroids PO, IV Acne, Weight Gain,
Hirsutism,
Cushingoid
Features
Cytarabine Antimetabolite IV, SQ Alopecia, Rash,
neurotoxicity
Daunorubicin Anthracycline IV Myelosuppression,
Metabolic Arrythmias
Hydroxyurea Antimetabolite PO Nausea and
Vomiting,
Stomatitis
Idarubicin Anthracycline IV Alopecia,
Metabolic Cardiotoxicity
Vincristine
12/07/21 Plant Alkaloid IV Peripheral 20
Neuropathy, Seizure,
Constipation
12/07/21 21