CHILDHOOD

LEUKEMIA
By: Casey Gatto, Nicole Garancsi, Elizabeth
King
 What is Leukemia?

Definition: a cancerous, progressive illness that

causes the bone marrow and other organs that make
blood to develop an excess of immature or aberrant
leukocytes. These inhibit the generation of healthy
red blood cells, which results in anemia and other
symptoms.
What is Leukemia? (Cont.)
Pathophysiology: “an actual blood cancer that results from a loss of
normal cellular regulation , leading to uncontrolled production of
immature WBCs (“blast” cells) in the bone marrow. As a result, the
bone marrow becomes overcrowded with immature, nonfunctional
cells, and production of other normal blood cell types is greatly
decreased. Leukemia may be acute, with a sudden onset, or chronic,
with a slow onset and symptoms that persist for years” (Workman,
2021, p.802)
 Cause and Most Affected Population
● Cause
○ True cause is unknown
○ Genetic and environmental
factors
○ Abnormal chromosomes in
50% of the patients
● Affected Population
○ Most common in children
under the age of 20 years old
● 5 Year Survival Rate (2013-2019)
○ 66.7% (National Cancer Institute, 2023)
● High WBC count
● Fatigue pallor of Symptoms
conjunctiva
● Open and infected lesions ● Decreased activity level
● Hematuria ● Recurrent fever
● Headache ● Petechiae / more bruising
than normal
● GI upset (stomach aches,
weight loss, anorexia,
bleeding gums)
● Leg pains/refusal to walk

Signs
 Treatment

● Chemotherapy
● Radiation
● Stem Cell Transplant (replenish healthy cells)
● Blood transfusion (if needed when counts get too
low)
Prevalence of Leukemia (Stats for 2023 according to
National Cancer Institute)

59,610
Estimated new
Cases

23,710
Estimated
Deaths (National Cancer Institute,
2023)
PATIENT CARE
● Standardized education checklist
for parents
○ On the checklist there are primary,
secondary, and tertiary points
● When taking care of children the
parent’s needs must also be met
 Teaching Points for Parents

Always Wash
Hands Treatment Side
Parents should be taught
Fever
Effects
to always wash hands The parents need to be
The parents need to aware of when to take the
especially before coming
be able to identify child to the ER due to fever
into contact with the child
side effects
 Secondary Teaching Points
Effects of Cancer
Bathing or on Digestive
Nutrition
Swimming System
● The child need to stay
● Let parents know that the
●
hydrated
Plenty of protein, carbs, and
Precautions child might be less hungry
fats need to be included in the ● Children with cancer while getting treatments.
diet should not swim in a Children might also
● A dietary supplement may pool because of the experience nausea, vomiting,
need to be added risk of disease and diarrhea.
transmission
● The child can bathe (if
a central line is present
it cannot get wet)
 Standards of Pediatric Nursing Practice Created
by the Association of Pediatric Oncology Nurses
Neutropenic Precautions
● Monitor child for a fever (if greater than 38.5 ℃, notify PCP)
● Implement protective isolation as indicated by institutions policy
● Maintain strict handwashing
● Avoid crowded areas and contact with individuals known to have infectious
illnesses
● Avoid urinary catheterization and the use of anal thermometers
● Avoid contact with plants and flowers
● Practice meticulous oral, personal, and perianal hygiene on a daily basis
● Notify the health care provider if the child is exposed to varicella (Bryant, 2003)
● Avoid live virus vaccines
 Implementation of Neutropenic
Precautions by Oncology Nurses in
● 113 nurses from an oncologyEthiopia
ward in Ethiopia were given a questionnaire
regarding infection control practices.
● 88.6% of the nurses answered that neutropenic patients must be placed in a
private room.
● Only 27.3% of nurses were observed performing hand hygiene before coming
into contact with the patient with neutropenic precautions.

Summary: The nurses were not adhering to the standard neutropenic precautions.

Recommendation: Trainings regarding neutropenic precautions must be designed

to improve infection prevention and in turn the patients’ outcome. (Ayele et al., 2023)
 Question 1.
A nurse analyzes the lab values of a child with leukemia who is
receiving chemotherapy. The nurse notices that the platelet count is
19,500 cell/mm3. Based on this lab value which intervention
would the nurse document in the plan of care?
A. Monitor the patient closely for signs of infection.
B. Check the patient's temperature every four hours.
C. Place the patient in isolation precautions
D. Use a soft toothbrush for oral care
 Question 1. Answer
Correct Answer is C.

Rationale: Leukemia is a malignant increase in the number of

leukocytes, usually at an immature stage, in the bone marrow. It
affects the bone marrow, causing decreased erythrocytes,
infection from neutropenia, and bleeding from decreased
platelet production. If the platelet count is less than 20,000 then
bleeding precautions need to be taken.
 Question 2.
After a client is admitted to the pediatric unit with a
diagnosis of acute lymphocytic leukemia, the laboratory
test indicates that the client is neutropenic. The nurse
should perform which of the following?
A. Advise the client to rest and avoid exertion
B. Prevent client exposure to infections
C. Monitor the blood pressure frequently
D. Observe for increased bruising
 Question 2. Answer
Correct Answer is B. Prevent client exposure to infections

Rationale: Neutropenia is a decreased number of

neutrophil cells in the blood which are responsible for the
body's defense against infection. Rest and avoiding
exertion would be related to erythrocytes and it’s oxygen
carrying properties. Monitoring the blood pressure, and
observing for bruising would be related to platelets and are
sign and symptoms of bleeding.
 Question 3.
A nurse is taking care of three pediatric clients receiving
chemotherapy, which client should the nurse see first?
A) A child who is nauseous
B) A child who has a WBC of 4,000
C) A child who is complaining of fatigue
D) A child with a fever of 103.5 F (39.4 C)
 Question 3. Answer
Correct Answer is D

Rationale: A Child who is nauseous and a child

complaining of fatigue would not be priority because these
are common side effects of chemotherapy. A WBC count
of 4,000 is low but because of the treatment this is to be
expected. Answer D is correct because any temperature
above 38.5 ℃ should be reported to the pediatrician.
 References
Ayele, A., Tsige, Y., & Boka, A. (2023). Nurses’ knowledge and care practices for infection prevention in chemotherapy-induced
neutropenic patients. International Journal of Africa Nursing Sciences, 19, 100604.
https://doi.org/10.1016/j.ijans.2023.100604

Bryant, R. (2003). Managing side effects of childhood cancer treatment. Journal of Pediatric Nursing, 18(2), 113–125.
https://doi.org/10.1053/jpdn.2003.11

National Cancer Institute. (2023). Leukemia - Cancer Stat Facts. SEER. https://seer.cancer.gov/statfacts/html/leuks.html

Rodgers, C., Bertini, V., Conway, M. A., Crosty, A., Filice, A., Herring, R. A., Isbell, J., Lown DrPH, E. A., Miller, K., Perry, M.,
Sanborn, P., Spreen, N., Tena, N., Winkle, C., Darling, J., Slaven, A., Sullivan, J., Tomlinson, K. M., Windt, K.,
Hockenberry, M., … Landier, W. (2018). A Standardized Education Checklist for Parents of Children Newly Diagnosed
With Cancer: A Report From the Children's Oncology Group. Journal of pediatric oncology nursing : official journal of
the Association of Pediatric Oncology Nurses, 35(4), 235–246. https://doi.org/10.1177/1043454218764889

Workman, D.I.M. L. (2021). Medical-Surgical Nursing (10th ed.). Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323654050
A PICTURE IS WORTH
A THOUSAND
WORDS