Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

ISO 9001:2015 CERTIFIED
Cabanatuan City
College of Nursing
 
EDUARDO L. JOSON MEMORIAL HOSPITAL
PEDIATRIC WARD
 

ACUTE LYMPHOCYTIC LEUKEMIA

Presented by:
DATU, BEVERLY JANE L.
DE LARA, BIANCA JESMINE
DEL ROSARIO, TRIXIE
DOMINGO, PRECIOUS MAE
NEUST SN’21
 

 
SEVILLA GUINTO, MAN, RN
Clinical Instructor
 
CHAPTER 1
1.1 General Objectives

As a level II NEUST-CON student nurse, the

general objectives of this case study was able
to acquainted with realization, understanding
the constant overall disease, improved our skills
and acquiring a way of frame of mind as
necessary in dealing with diverse clients,
performing basic nursing skills with confidence
and competence as well as providing an
appropriate nursing management to a pediatric
patient incapable of dealing with leukemia.
 1.2 Specific Objectives
At the end of the clinical duty the students will be
able to:
Perform a head-to-toe assessment to the patient,
formulate a nursing diagnosis and focus on the
part affected by the Acute Lymphocytic Leukemia;
Comprehend the precipitating and predisposing
factors that can possibly lead to occurrence of
Acute Lymphocytic Leukemia;
Obtain, document and provide a reliable medical
history related to present condition.
Explain the anatomy and physiology of Blood;
1.2 Specific Objectives

Understand the pathophysiology of Acute

Lymphocytic Leukemia;
Gain knowledge about the suggested
medical management and its uses;
Formulate a specific Nursing Care Plan
appropriate for the patient;
Formulate a drug study related to the
medications for the patient’s condition;
Provide information about the discharge and
home management plan.
 INTRODUCTION

Children with leukemia or lymphoma experience signs

and side effects that are not the same as those faced by
adults. A pediatric patient's condition will rapidly
deteriorate, presenting a medical challenge for the healthcare
team. A dedicated pediatric hematology oncology clinic will
help guarantee a favorable result for sick children and teens
with cancer by diagnosing, treating, and intervening.

Acute lymphocytic leukemia, also known as acute

lymphoblastic leukemia (ALL) is the most common hematologic
malignancy found in children. Fortunately, ALL is treatable
and can be cured. Survival rates have increased dramatically
in recent decades due to advances in research and
chemotherapy treatment (National Cancer Institute, 2012).
 INTRODUCTION

This course will discuss childhood

leukemia and lymphoma, as well as
childhood cancer rates, lifesaving
care, treatment side effects, and the
stressors and psychosocial problems
that come with a childhood cancer
diagnosis.
 Client’s Data:

Name: Patient X
Age: 4 years old
Gender: Male
Status: Single
Date of birth: January 29, 2017
Address: Mayapyap Sur, Cabanatuan
City
Religion: Roman Catholic
 Client’s Data:

Date & time of admission: March 10,2021, 2:42PM

Admitting Physician: Dr. Besa
Admitting Diagnosis: Acute Lymphocytic
Leukemia
Final Diagnosis:
Initial Vital Sign:
 BP: 140/90 mmHg
 T: 37.0C
 PR: 92bpm
 RR: 24cpm
 FAMILY HISTORY

There is a family history of the

Leukemia on maternal side as claimed
by his mother.
 ADMITTING HISTORY

A 4-year-old client named X, Roman

Catholic, born on January 28, 2017, and
living in Mayapyap Sur, Cabanatuan City was
admitted at 10th day of March 2021 at 8 am
by referring from Dr. A. The client
experiences difficulty in breathing, fever,
sweating and shivering, has swollen lymph
nodes, and loss of appetite. The mother is
the primary historian and is deemed reliable.
 HISTORY OF PAST ILLNESS

The patient had previous

hospitalization due to
bronchopneumonia 5 months ago.
 STATUS OF PRESENT ILLNESS

Five days prior to admission, patient

manifested bruises and petechiae. No
consultation done.
Two days prior to admission, patient developed
moderate grade fever associated with decreased
of appetite and body weakness. Mother stated
that the condition of her child worsen as she
seems to noticed sweating and shivering of her
child which made the child to have a shortness
of breath. She also noticed swollen lymph nodes
while taking care of her child.
 STATUS OF PRESENT ILLNESS

Few hours prior to admission,

persistence of above condition, prompt to
consult to a hospital in Cabanatuan City.
The mother stated that the condition of
her child worsen as she seems to noticed
sweating and shivering of her child which
made the child to have a shortness of
breath. She also noticed swollen lymph
nodes while taking care of her child.
 PHYSICAL HEALTH ASSESSMENT

(Head to Toe Assessment)

General Conscious and coherent  
 
Body Parts Normal Actual Assessment Result
Findings
Rounded
Skull  Rounded shape, symmetrical Normal
(normocephal
  ic and  
symmetrical,
with frontal,  
parietal, and
occipital
prominencess
mooth skull
contour.
Scalp Smooth  Absence of nodes or masses. Normal
  uniform  
consistency;
 
absence of
nodes
Hair  Evenly distributed hair,
  thick hair, no infection, and
no presence of dandruff,
silky and resilient hair.
Face  Symmetric or slightly
  asymmetric facial features;
palpebral fissures equal in
size.
Eyes • Eyebrows and Eyelashes are
  evenly distributed, the eyelids
has no discharge and no
discoloration; pupils are black
in color; round, equal in size
normally 3-7 mm in diameter;
conjunctiva pink in color, the
sclera are white in color.
 Hair is black in color, no Thin hair
evidence of alopecia, V due to
however, thin hair is presence; ALL
no pediculosis and dandruff.
 Symmetrical facial features Normal
• Eye brows and eye lashes are Normal
evenly distributed, eyes are dark
brown in color, Sclera is white in
color, light accommodation, pupils
are black in color and equal in size,
no lesions or discharge in
conjunctiva and is pink in color
  Lips pink in
 Presence of dryness, teeth are intact, no Dryness is presence due
Mouth
color, soft,
moist, smooth
inflammation in uvula and tonsil, tongue to dehydration.
texture, ability is in central position
to purse lips;
the teeth are
smooth, white,
firm texture to
the gums.
Tongue is in
central position,
pink in color
moist

Ears  same as  Color same as facial skin, Normal

facial skin,
  Symmetrical auricle alignment with
symmetrical,
auricle outer cantus of eyes. Ear wax, pinna
aligned with recoils after it is folded and able to  
outer cantus
hear sound in both ears
vertical, able  
to hear sound
in both ears
Nose and • Symmetric  No discharge, symmetrical Normal
Paranasal and straight no and straight alignment,
discharge or
Sinuses uniform in color. No
flaring,
  tenderness and lesions
uniform color.
No tenderness
and no
lesions.

Neck • Muscle equal  Uniform in color, no Normal

  in size; head lumps/masses, no pain when
centered; head
swallowing, head centered
movement is
coordinated
and in smooth
movement. No
enlarge lymph
node.
 • Quiet,
 It may need adequately
Chest rhythmic Shortness of breathing is
  respiration, retractions when breathing, use
caused by ALL
normal of accessory muscle used when
breathing breathing; symmetrical chest
 
rate, no
retraction movement is insight.
when
breathing
• Varies to Equal in strength Normal
Thorax some degree
in
accordance
with
person’s
genetic
makeup and
degree of
physical
activity
 • Uniform • Uniform in color, skin intact, Normal
Abdomen
color, no soft, no tenderness, positive
  evidence borborygmi sound.
of enlarged
liver or
spleen.
Audible
bowel
sounds,
absence at
arterial
bruits, and
absence at
friction
rubs, no
tenderness.
 • Uniform color, • Pallor skin, bruises and Pallor skin, bruises,
 Skin petechiea is present on
except in the and Petechiea is a
  areas exposed upper body. result of ALL
to the sun, no
bruises/petechi
ea present and
no other
lession.

• smooth texture,  Uniform in color, no Normal

Extremities when fractures, symmetrical in
  performing the movement, has some rash in
blanch test of
right foot, nail beds are pink
capillary refill it
is prompt return in color, capillary refills at
of usual color 2-3 seconds
 • Perineum • Presence is smoothness; Normal
Genital Area is Smooth, balance shape and color.
Slightly
darkened,
color and
shape is
normal 
This table shows the physical
assessment indicates that all body
parts are normal except hair, mouth,
chest, extremities and skin.
CHAPTER 2
 DEFINITION

A Leukemia is a cancer of the blood

cells. There are several broad categories
of blood cells, including red blood cells
(RBCs), white blood cells (WBCs), and
platelets. Generally, leukemia refers to
cancers of the WBCs. WBCs are a vital part
of your immune system. They protect your
body from invasion by bacteria, viruses,
and fungi, as well as from abnormal cells
and other foreign substances.
 DEFINITION

In leukemia, the WBCs don’t function like normal

WBCs. They can also divide too quickly and eventually
crowd out normal cells. WBCs are mostly produced in
the bone marrow, but certain types of WBCs are also
made in the lymph nodes, spleen, and thymus gland.
Leukemia can be either acute or chronic. Chronic
leukemia progresses more slowly than acute leukemia,
which requires immediate treatment. There are four
broad classifications of leukemia: Acute lymphocytic
leukemia (ALL), Acute myelogenous leukemia (AML),
Chronic lymphocytic leukemia (CLL) and Chronic
myelogenous leukemia (CML). Leukemia occurs in both
adults and children.
 DEFINITION

ALL is the most common form of childhood

leukemia. Acute lymphoblastic leukemia (ALL) is a
type of blood cancer that starts in white blood cells in
your bone marrow, the soft inner part of your bones.
It develops from immature lymphocytes, a kind of
white blood cell that’s key to your immune system.
ALL is also known as acute lymphocytic leukemia or
acute lymphoid leukemia. “Acute” means it gets
worse quickly. Acute lymphoblastic leukemia invades
your blood and can spread to other organs, such as
your liver, spleen, and lymph nodes. But it usually
doesn’t make tumors like other types of cancer.
 ANATOMY AND PHYSIOLOGY

Leukemia is a type of cancer with

uncontrolled production of immature white
blood cells (usually blast cells) in the bone
marrow. As a result, the bone marrow
becomes overcrowded with immature,
nonfunctional calls and production of normal
blood cell is greatly decreased. Leukemia may
be acute, with sudden onset and short
duration, or chronic with a slow onset and
symptoms that persist for a period of years.
 ANATOMY AND PHYSIOLOGY

Leukemia is classified by cell type. Abnormal

leukemic cells coming from lymphoid pathways
are lymphocytic or lymphoblastic. Leukemia in
which the abnormal cells come from the myeloid
pathways are myelocytic or lymphoblastic.
Several subtype exist for each of these diseases,
which are classified according to the degree of
maturity of the abnormal cell and the specific
cell type involved. With leukemia, cancer occurs
in the stem cells or
 ANATOMY AND PHYSIOLOGY

These cells are abnormal and their excessive production in

the bone marrow stops normal bone marrow production of
red blood cells, platelets, and mature leukocytes. Anemia,
thrombocytopenia, and leukopenia result. The number of
immature, abnormal white blood cells in the blood is
greatly elevated. Leukemic cells can also be found in the
spleen, liver, liver nodes and central nervous system.
Without treatment, the client dies of infection or
hemorrhage. For clients with acute leukemia, the changes
occur rapidly and, without intervention, progress to death.
Chronic leukemia may be present for years before changes
appear.
Pathophysiology of Acute Lymphocytic
Leukemia
 PATHOPHYSIOLOGY
(Book-based)
Leukemia is a type of cancer with uncontrolled production of immature white blood cells
(usually blast cells) in the bone marrow. As a result, the bone marrow becomes
overcrowded with immature, nonfunctional calls and production of normal blood cell is
greatly decreased. Leukemia may be acute, with sudden onset and short duration, or
chronic with a slow onset and symptoms that persist for a period of years.
 Leukemia is classified by cell type. Abnormal leukemic cells coming from lymphoid
pathways are lymphocytic or lymphoblastic. Leukemia in which the abnormal cells come
from the myeloid pathways are myelocytic or lymphoblastic. Several subtype exist for each
of these diseases, which are classified according to the degree of maturity of the abnormal
cell and the specific cell type involved. With leukemia, cancer occurs in the stem cells or
early precursor leukocyte cell, causing excessive growth of a specific type of leukocyte.
These cells are abnormal and their excessive production in the bone marrow stops normal
bone marrow production of red blood cells, platelets, and mature leukocytes. Anemia,
thrombocytopenia, and leukopenia result. The number of immature, abnormal white blood
cells in the blood is greatly elevated. Leukemic cells can also be found in the spleen, liver,
liver nodes and central nervous system. Without treatment, the client dies of infection or
hemorrhage. For clients with acute leukemia, the changes occur rapidly and, without
intervention, progress to death. Chronic leukemia may be present for years before changes
appear.
 PATHOPHYSIOLOGY
(Client-based)
The diagram shown is the pathophysiology of Acute Lymphocytic
Leukemia. Due to precipitating factor which is having a family history of
Leukemia in maternal side and predisposing factor such as age, it has a
high possibility of acquiring the disease despite the etiology being
unknown. The damage to DNA causes lymphoid cells in the bone marrow
to undergo uncontrolled growth due to reproduction of lymphoblast
without developing into normal blood cells. Then the lymphoblast
replaces the normal marrow elements resulting to a decreased
production of normal blood cells wherein the clinical manifestation in
the patient are showing such as Petechiae, bruises and bleeds easily,
pallor, fatigue and weakness, dyspnea, fever, and swollen lymph nodes.
Then immature WBCs spill into bloodstream and from there infiltrate
other tissues and eventually, this infiltration results in organ
malfunction because of encroachment and hemorrhage.
CLINICAL MANIFESTATION
Book Based Client Based
These are the common sign and symptoms for pediatric:  Presenting Complaints:
 Bruises and petechiea
 Fever  Fever
 Pale skin  Pallor
 Swollen lymph nodes
 Bleeding
 Persistent fatigue and weakness
 Anorexia  Sweating chills or shivering
 Fatigue and weakness  Shortness of breath
 For Bone, joint and abdominal pain is presence
 Generalized lymph-adenopathy
 Infection
 Hepatomegaly
 Splenomegaly
 Headache
 Mouth sores
 Increased ICP (nausea, vomiting, lethargy, cranial nerve
dysfunction
 RISK FACTORS
Factors that may increase the risk of acute lymphocytic
leukemia include:
Previous cancer treatment. Children and adults who've had
certain types of chemotherapy and radiation therapy for other
kinds of cancer may have an increased risk of developing acute
lymphocytic leukemia.
Exposure to radiation. People exposed to very high levels of
radiation, such as survivors of a nuclear reactor accident, have
an increased risk of developing acute lymphocytic leukemia.
Genetic disorders. Certain genetic disorders, such as Down
syndrome, are associated with an increased risk of acute
lymphocytic leukemia.
 MEDICAL MANAGMENT
In general, treatment for acute lymphocytic leukemia falls into separate phases:
Induction therapy. The purpose of the first phase of treatment is to kill most of
the leukemia cells in the blood and bone marrow and to restore normal blood cell
production.
Consolidation therapy. Also called post-remission therapy, this phase of
treatment is aimed at destroying any remaining leukemia in the body.
Maintenance therapy. The third phase of treatment prevents leukemia cells from
re-growing. The treatments used in this stage are usually given at much lower
doses over a long period of time, often years.
Preventive treatment to the spinal cord. During each phase of therapy, people
with acute lymphocytic leukemia may receive additional treatment to kill
leukemia cells located in the central nervous system. In this type of treatment,
chemotherapy drugs are often injected directly into the fluid that covers the
spinal cord.
Depending on your situation, the phases of treatment for acute lymphocytic
leukemia can span two to three years.
 Diagnostic Tests (Book Based)

Tests that may be done include:

CBC
XRAY
Bone Marrow test
 NURSING MANAGEMENT

The care plan for the leukemic patient should

emphasize comfort, minimize the adverse effects of 
chemotherapy, promote preservation of veins,
manage complications, and provide teaching and
psychological support.
Before treatment:
Education. The nurse should explain the disease
course, treatment, and adverse effects to the
parents, guardians, or significant others.
Infection. The nurse should teach the patient and
his family how to recognize symptoms of infection
such as fever, chills, cough, and sore throat.
 NURSING MANAGEMENT

Bleeding. The nurse should educate the patient and

the family how to recognize abnormal bleeding
through bruising and petechiae and how to stop it
with direct pressure and ice application.
Promote good nutrition. The nurse should explain
that chemotherapy causes weight loss and
anorexia, so the patient must be encouraged to eat
and drink high-calorie and high-protein foods and
beverages.
Rehabilitation. The nurse should help establish and
appropriate rehabilitation program for the patient
during remission.
 NURSING MANAGEMENT

Preventing and Managing bleeding:

Watch for signs of minor bleeding, such as
petechiae, ecchymosis, conjunctival
hemorrhage, epistaxis, bleeding gums,
bleeding at puncture sites.
Be alert for signs of serious bleeding, such as
headache with change in responsiveness,
blurred vision, hemoptysis, hematemesis,
melena, hypotension, tachycardia, dizziness.
Test all urine, stool, emesis for gross and
occult blood.
CHAPTER 3
 LABORATORY RESULT

Table 1. Sample CBC Test Result Diagnosed in

ALL.
Parameter Diagnosis of AA Recovery   Diagnosis of ALL
 
    Case 1  
Time (weeks) 0 3 15
Hemoglobin (g/dL) 5.0 10.0 15.3
Leukocytes (x 10 /L)
9
0.209 5.0 83.07
Peripheral blood blasts (%) 0 0 80

Neutrophils (x 109/L) 0.006 2.0 37.85

Platelets (x 109/L) 4.9 170.0 121 .0
    Case 2  
Time (weeks) 0 2 18
Hemoglobin (g/dL) 1.7 11.0 4.6
Leukocytes (x 109/L) 1.18 5.04 28.3
Peripheral blood blasts (%) 0 0 70

Neutrophils (x 109/L) 0.546 1.93 0.146

Platelets (x 10 /L)
9
8.0 110.0 8.6
 Table 2. Formulated CBC test result
of the client.
Complete Blood Count (CBC)

  Normal Results Interpretation Clinical Significance

WBC 5.00 - 6.00 g/L 7.35 g/L Not Normal Excess production of WBC
count unable to fight
infection.

RBC 4.50 – 7.00 L 2.50 L Not Normal Risk of anemia and low
progress of RBC

Hgb 140 – 170 g/L 126 g/L Not Normal Presence of anemia

        Presence of
Platelet 200 – 400 g/L 151 g/L Not Normal thrombocytopenia
 LABORATORY RESULT

FRONTAL CHEST XRAY

Figure 1. Presence of Leukemia

A appearance chest x ray (figure 1)

showed some abnormality. There is mediastinal
lymphadenopathy. The lungs are clear and the
heart is normal. No effusion. In the image
above was a markedly elevated WBC count, the
chest x-ray appearances are consistent with
adenopathy secondary to a hematogenous
malignancy. The blood film confirmed ALL. No
further imaging was obtained.
 LABORATORY RESULT

ABDOMINAL XRAY
Figure 2. Presence of Leukemia
(Abdominal x-ray)
An appearance (figure 2) showed some
abnormality. A Four year old boy abdominal
ultrasound revealed bilateral
nephromegaly. On a sagittal section of the
right flank, enlarged kidney on that side
(sagittal diameter of 9.0 cm) and slightly
increased echogenicity are observed. The
CT scan also releaved the boy is diagnosed
with ALL.
 LABORATORY RESULT

BONE MARROW TESTING

Table 3. Sample Result of Bone Marrow
testing
A four year old boy was tested in a
bone marrow test. Given by the
collected sample, the table shows that
disease is affecting blood cells or
marrow, as well it is monitored that may
be extent of the disease. It was
detected in marrow samples that the
child is suffering from ALL.
CHAPTER 4
NCP
 Assessment Diagnosis Outcome Planning Intervention Rationale Evaluation
identification
    Goal/Objectives:        
Subjective: Impaired skin Within 8 hours of Place the patient in a Protect patients After 8 hours of
  integrity related to   nursing private room. Limit from any potential nursing
“Napansin ko na inflammatory Skin will remain intervention, the visitor as needed. sources of intervention, the
madalas ang response to a intact and patient identifies   infections. patient was able to
pagkakaroon niya ng various infection. absence of the actions to     identify the actions
pasa at palagi na bruises reduce and Prohibited the use of Prevents cross to reduce and
lang siyang prevent the live plants or cut contamination to prevent the
nangangati.” As bruises and flowers. reduce the bruises and
verbalized by the Mucous petechial.   infections. petechial.
client’s mother. membrane will      
  remain intact. Instruct the client’s Making sure the Goal met
  mother to restrict patient is away from
Objective: fresh fruits and any harm objects.
  Protected from vegetable. Make sure  
Irritability entering various they are peeled.  
  infection that    
Facial Mask of pain would worsen Require a good hand  
  the AML. washing protocol for Proper hand
Pallor of skin and all personnel and washing may
mucus membrane   visitors. prevent from
    viruses.
Low Fluid intake Encourage frequent  
  turning and deep  
Dryness of Skin breathing. May prevent from
    stasis of respiratory
    secretions and
  reducing symptoms
  of leukemia.
Avoid any physical  
activity.  
 Outcome
Assessment Diagnosis Planning Implementation Rationale Evaluation
Identification
Subjective: Shortness of The client will Short term: Independent   After 4 hours of
“Nahihirapan ang anak breath related Within 4 hours of interventions;   nursing
ko sa paghinga.” to the cooperate in nursing intervention the
Verbalized by the clumping of ways to improve intervention the Establish rapport To gain patient’s trust client will be
mother of the client cell around client will be able   and cooperation able to verbalize
  the thymus airway patency to verbalize   understanding
 
Objective: gland as instructed by understanding   That may restrict limit and
  evidenced by the nurse. and demonstrate Assess for pain/ respiratory effect demonstrate
  the presence proper deep discomfort   proper deep
Wheezing upon of secretions   breathing   breathing
inspiration and The client will technique to   Elevation of the bed technique to
expiration facilitate proper Elevate head of the bed facilitates respiratory facilitate proper
display/maintain oxygenation oxygenation
  function.
Nasal Flaring patent airway      
  with breath Long term: Encourage or assist with Provides client with After 24 hours
Within 24 hours abdominal or pursed lip some means to come of nursing
sounds clearing. of nursing breathing exercises. with or control reduce intervention,
  intervention, the   air trapping the client will
client will   establish normal
establish normal   breathing
breathing pattern. Dependent Intervention:   pattern.
 
Administer oxygen at For management Goal met.
lowest concentration underlying pulmonary
indicated and prescribed condition, respiratory
respiratory medication distress or cyanosis
   
Administer oxygen To support respiration
and maintain a normal
inhalation as prescribed. oxygen saturation in the
  blood.
   
 
 Assessment Diagnosis Outcome Planning Implementation Rationale Evaluation
Identification
Subjective: Cancer-related Goal/Objectives: Short term: Establish rapport Building rapport Client
“Pagod nako, fatigue as   Within 3 hours with the client. aims to get the verbalized
gusto kong manifested by The client will of nursing   client feel relax feelings
matulog” as lack of energy cooperate during intervention, Encourage and of increased
verbalized by and disinterest nursing the client will verbalization of comfortable. energy and
the patient. in the interventions. manifest feelings about the   improved
  surroundings.   reduced impact of fatigue. Acknowledgeme well-being.
Objective: The client will irritability and   nt that living  
Irritability verbalize increased positive Restrict with fatigue is Client
  energy. attitude. environmental both physically demonstrates
Muscle     stimuli, especially and emotionally a
weakness The client will have   during planned challenging more positive
  improved well- Long term: times for rest and helps in coping. attitude and
Difficulty being. Within 24 sleep.   active social
climbing stairs   hours of Vivid lighting, activity
or walking The client will nursing Assist the patient noise, visitors, than before
short distances demonstrate active intervention, with setting and numerous the
  social activity. the client will priorities for distractions in interventions
Sleep   manifest preferred activities the patient’s were applied.
disturbances The client will improve sense physical  
  maintain well- of energy. Provide comfort surroundings Client
Withdrawal being. such as judicious can limit maintains
from leisure   touch relaxation, overall well-
and/or social disturb rest or being.
activities Educate the family sleep, and
about task contribute to
organization fatigue.
methods and time  
organization Setting priorities
methods. is one sort of an
  energy
  conservation
  method that
 ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION RATIONALE EVALUATION
IDENTIFICATIO
N
            After 4 hours of nursing
Subjective: Activity Report a After 4 hours of Evaluate reports of Effects of leukemia, anemia, and intervention, the
Intolerance measurable nursing fatigue, noting inability chemotherapy may be cumulative patient participated in
“Napapansin ko na to participate in
nanghihina at parang related to increase in intervention, the activities or ADLs
(especially during acute and ADLs level of ability.
hinihingal pa yung imbalance activity client will be   active treatment phase),  
anak ko kahit simple between tolerance. able to have an Encourage the necessitating assistance. After 24 hours of
oxygen supply   improvement in guardians or parents of   nursing intervention,
lang yung mga and demand activity the patient to keep a Helps the parents or guardians of
Participate in the patient
ginagawa niya kaya as evidenced tolerance. diary of daily routines the patient to prioritize activities demonstrated a normal
ADLs to level of
hindi na siya by verbal ability.   and energy levels, and arrange them around fatigue vital signs and normal
masyadong noting activities that
report of   Long term: After increase fatigue. pattern. breathing pattern.
nakakapaglaro ng mga fatigue or Demonstrate a 24 hours of      
laruan niya.” weakness and decrease in nursing Provide quiet Restores energy needed for Goal was met.
  dyspnea physiological intervention, the environment and activity and cellular regeneration
Objective: signs of client will have a uninterrupted rest and/or tissue healing.
  intolerance; normal vital periods. Encourage rest  
signs and periods before meals. Maximizes available energy for
Fatigue or weakness e.g., pulse,  
  respiration, and demonstrate a Implement energy- self-care tasks with the assistance
Shortness of breath  BP remain normal saving techniques of parents or guardians of the
  within patient’s breathing (sitting, rather than patient.
normal range. pattern. standing, use of shower  
  chair). Assist with May enhance intake by reducing
ambulation and other nausea
activities as indicated.
   
Schedule meals around Smaller meals require less energy
chemotherapy. Give for digestion than larger meals.
oral hygiene before Increased intake provides fuel for
meals and administer energy.
anti-emetics as  
indicated.
  Maximizes oxygen available for
Recommend small, cellular uptake, improving
nutritious, high-protein tolerance of activity
meals and snacks
throughout the day.
 
Provide supplemental
oxygen.
CHAPTER 5
 DRUG STUDY
Drug name Mechanism Dosage Indications Contraindic Adverse Nursing alert
of action ations reactions
Generic name: Cerubidine   Cerubidine Cerubidine Acute Reactions: Treat if any systemic
Cerubidine (daunorubicin Children: (daunorubicin) in (daunorubicin) is Rarely, infections. Pre-existing
  hydrochloride) is the Injectable combination with contraindicated in anaphylactoid drug-induced bone
Brand name: hydrochloride salt of Solution: other approved patients who have reaction, fever, and marrow suppression.
Daunorubicin an anthracycline 1mg/mL anticancer drugs is shown a chills can occur.  
cytotoxic antibiotic   indicated for remission hypersensitivity to   Cardiovascular disease,
produced by a strain of Powder for induction in acute it. Hyperuricemia may thoracic irradiation,
Streptomyces Injection: nonlymphocytic occur, especially in previous doxorubicin
coeruleorubidus. It is 25mg leukemia patients with therapy (cumulative
provided as a sterile   (myelogenous, leukemia, and serum doses >550mg/m2):
reddish lyophilized monocytic, erythroid) uric acid levels increased risk of
powder in vials for of adults and for should be cardiotoxicity.
intravenous remission induction in monitored.  
administration only. acute lymphocytic   Monitor blood counts,
Each vial contains 21.4 leukemia of children cardiac, hepatic and
mg daunorubicin and adults. renal function prior to
hydrochloride each treatment.
(equivalent to 20 mg of  
daunorubicin), and 100 Renal or hepatic
mg mannitol. It is impairment.
soluble in water when Hyperuricemia;
adequately agitated monitor blood uric acid
and produces a reddish levels and give
solution. allopurinol
prophylatically.
 
 
 DRUG STUDY
Name of the Mechanism of Dosage Indications Contraindication Adverse Nursing Alert Rationale
Drug action reaction
  Nelarabine is a            
Generic Name: cancer medicine Dosage: Treatment of Hypersensitivity to Anemia Perform a thorough To establish
Nelarabine that interferes 650 mg/m²  relapsed or nelarabine or any   physical assessment  baseline data
  with the growth   refractory T-cell component of the Fatigue   before drug
Brand Name: and spread of Frequency: acute lympocytic formulation     therapy begins,
Arranonâ cancer cells in the Every 1 hour leukemia/ Headache Assess for the  
  body. It is used to for 5 lymphoma   mentioned cautions To determine
Classification: treat T-cell acute consecutive following at least Peripheral and effectiveness of
Nucleoside lymphoblastic days: repeat 2 chemotherapy neurologic contraindications therapy, and to
analogue. leukemia (T-ALL) every 21 regimen disorder   evaluate for
and T-cell days.       occurrence of any
lymphoblastic Pain   adverse effects
lymphoma (T-LBL)     associated with
whose disease has Edema   drug therapy.
not responded to      
or has relapsed Fever Monitor result of To identify possible
following   laboratory tests such bone marrow
treatment with at Dyspnea as CBC with suppression and
least two   differential toxic drug effects
chemotherapy Vomiting   and establish
regimens.   appropriate dosing
  Pleural for the drug;
effusion  
   
 
 
 
-
 
 Name of the Drug Mechanism of action Dosage Indications Contraindication Adverse reaction Nursing alert Rationale
  Methotrexate enters tissues and is   Exfoliative dermatitis, serious Fever, Chills Obtain a current To avoid any possible drug
Generic Name: converted to a methotrexate Oral: Used to treat people rash  Swollen lymph medication history interactions before prescribing
Methotroxate polyglutamate by folylpolyglutamate.   who have Acute glands methotrexate.
    20 mg/m² lymphoblastic Anemia, bone marrow  Night sweats    
Brand Name: Methotrexate's mechanism of action PO qWeek leukemia (ALL) that suppression, herpes infection,  Weight loss Administer drug After To determine if the patient is
Trexall is due to its inhibition of enzymes   has spread to the immunosuppression,  Vomiting Negative Skin Test allergic to the medication
  responsible for nucleotide synthesis   central nervous infection, neutropenia,  White patches or    
Classification: including dihydrofolate reductase, system (CNS) or to requires an experienced sores inside the Monitor the patients  
Antimetabolite thymidylate synthase, prevent ALL to from clinician, thrombocytopenia, mouth or on lips regularly for toxicities To perform immediate
  aminoimidazole caboxamide spreading to CNS. varicella, viral infection  Diarrhea (especially bone marrow, intervention and prevent
  ribonucleotide transformylase       Blood in urine or lung, kidney, and liver.) further complications
(AICART), and amido Acquired immunodeficiency stools    
phosphoribosyltransferase. syndrome (AIDS)  Dry cough    
     Cough with mucus Continuation of  
Inhibition of nucleotide synthesis Diabetes mellitus, pulmonary  Chest pain appropriate dosing  
prevents cell division. disease, pulmonary fibrosis,  Wheezing and requires periodic To assure sufficient drug
  pulmonary toxicity   feeling short of monitoring of ANC and exposure (that is to maintain
  breath platelet count ANC at a desirable level) and to
Diarrhea, GI bleeding, GI  Seizures   adjust for excessive
disease, GI perforation, peptic  Little or no urination   hematological toxicity
ulcer disease, stomatitis, Swelling in feet or Report to the physician  
vomiting ankles about the toxicities and For the physician to replace the
   Stomach pain condition of the client. medication and be able to
Radiation therapy, sunburn, Dark urine determine what action to
sunlight (UV) exposure  Jaundice make.
   Confusion
Vaccination  Weakness
   Drowsiness
New primary malignancy  Coordination
  problems
 Feeling irritable
 Headache
 Neck stiffness
 Vision problem
Loss of movement of
any part of the body
 Tiredness
 Numbness or
tingling
 Muscle cramps
 Tachycardia
 Bradycardia
 
 Name of the Mechanism of Dosage Indications Contraindications Adverse reaction Nursing alert Rationale
drug action
Generic Suppresses Dosage: Used Active untreated   Monitor intake and To know how
name: inflammation and 0.15 mg, systematically and infections (except for CNS: output ratios and the system
Dexamethas the normal Orally/I locally in a variety certain forms of -severe daily weights. interacts with
one immune response. M/IV of disorders meningitis) depression,   the drug.
  Has numerous   including: Chronic   unusual thoughts    
  intense metabolic Frequenc inflammatory Avoid chronic use during or behavior,    
Brand effects. y: q6H disorders, lactation, may affect seizure,   Dexamethason
name:     Allergies, child’s growth. convulsions.   e can alter
Decadron Suppresses   Hematologic     Observe patient for weight, cause
  adrenal function diseases, Bisulfite, paraben, or Metabolic: appearance of swelling,
Classificatio   Neoplasm alcohol hypersensitivity-- -swelling, rapid peripheral edema, crackles or
n: Suppression of autoimmune some products contain weight gain, steady weight gain, dyspnea.
Anti- inflammation and disease, bisulfite, paraben or feeling short of crackles or dyspnea.  
inflammato modification of management of alcohol breath. Notify physician if  
ry normal immune Cerebral edema,     these occur. To minimize
agent/Gluco response and Septic shock. use cautiously: chronic     gastric
corticoids   treatment (will lead to CARDIOVASCULA   irritations.
  Diagnostic agent adrenal suppression); R: If dose is ordered  
in adrenal should never be abruptly -dangerously high daily, administer in To ensure
disorders discontinue. blood pressure the morning that the
(severe headache,   medication is
blurred vision,   given safely
buzzing in ears, Instruct the patient to and accurately
anxiety, confusion, take the medication .
chest pain, exactly as indicated  
shortness of and not to skip doses  
breath, uneven or double up on  
heartbeats, missed doses.  
seizure).  
 
 
CHAPTER 6
 EVALUATION AND FINDINGS

The nursing students were able to understand

the value of using a nursing process by delivering
clinical treatment and management for the patient
after completing the report. The client’s health
concerns were discovered by revealing the findings
of the laboratory examinations and identifying the
likely triggers of Acute Lymphocytic Leukemia. The
study has helped to increase the quality of nursing
care and management for the patient.
 EVALUATION AND FINDINGS

The study was addressed by enabling the factors that

cause Acute Lymphocytic Leukemia to be discovered. The
researchers become aware that Acute Lymphocytic
Leukemia is a blood cancer which is a form of leukemia
that appears suddenly and grows rapidly which has many
lymphoblast in the blood and bone marrow wherein it is the
most common hematologic malignancy in children.
Everything, fortunately, is treatable and curable due to
advances in science and chemotherapy treatment, survival
rates have risen significantly in recent decades. Moreover,
the treatment process is determined by the stage of
leukemia. Chemotherapy, biological therapy, targeted
therapy, radiation therapy, and stem cell transplant are all
common treatments for leukemia.
 EVALUATION AND FINDINGS

Every client deserved to be treated with

dignity by their healthcare providers. Only if
their patients have necessary experience,
expertise, and mindset for disease
management will be able to provide adequate
treatment. Understanding the cause or
predisposing factors of Acute Lymphocytic
Leukemia as well as the process that the
client is going through, allows student nurses
to offer holistic treatment and alleviate the
client’s concern and fears.
 RECOMMENDATIONS

Take the entire course of prescribed medication and

treatment. After a patient’s temperature returns to
normal, medication must be continued according to
the doctor’s instructions, otherwise, the Acute
Lympocytic Leukemia ay recur. Relapses can be far
more serious than the first attack.
Observe any reaction towards the given medications
and signs that needs to call the attention of the
physician.
Get plenty of rest. Adequate rest is important to
maintain progress toward full recovery and to avoid
relapse.
Encourage the patient to have healthy
lifestyle through eating a balanced diet,
drinking enough fluids, maintaining
healthy weight, and protecting oneself
from the sun. For pediatric patients,
educate and encourage their parents or
guardians about the healthy lifestyle.
Encourage hand washing, washing of
fruits and vegetables and maintaining a
good personal hygiene to prevent
infection.
Keep all follow-up appointments. It’s
important to have doctor monitor his
progress.
Encourage the patient’s parents to
have a support system for the
patients. Support can contribute to
patient’s ability to cope what lies
ahead thus helping to ease anxiety.