Question

I. Read Chapters 40 to 43 from your Textbook

II. NCLEX REview Questions Chapters 40 to 43 from Evolve Resources

III. Acute Lymphocytic Leukemia

A father brings in his 3-year-old son, James, who was initially running a fever. He was given Tylenol, and the fever went away for 2 days. Now, however, the fever is back, and he has noted dark spots on his body and a lump in his armpit. He has been lethargic and has not wanted to eat for the last 24 hours. The physician suspects acute lymphocytic leukemia and has ordered blood chemistry studies, immunophenotyping, and bone marrow aspiration and biopsy.

The father is upset and wants to know what is leukemia and how did his son catch it? How would the nurse address this question?

The nurse arranges to have laboratory tests drawn and schedules the immunophenotyping and bone marrow aspiration and biopsy. Discuss the importance of these tests.?

Is there a possibility that leukemia has spread in the body?

What treatments are available for leukemia?

Answer 1

A. At first nurse will provide psychological support to the father. Then she will inform the father that a malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. These suppress the production of normal blood cells, leading to anaemia and other symptoms.

Now nurse will inform the fathe that there are several causes of leukemia. As genetic disorders, exposure to certain chemicals eg. benzene — which is found in gasoline and is used by the chemical industry, previous cancer treatment , family history of leukemia, smoking. These are the risk factors for leukemia .

B. CBC will done to know if WBC count is abnormal or not.

Immunophenotyping is done to detect abnormal cells whose pattern of markers are typically seen with specific types of leukemia.

Bone marrow aspiration and biopsy will be done to know which type of leukemia is it.

C. Yes there is a possibility that leukemia has spread in the body as dark spots on his body and a lump in his armpit. He has been lethargic and has not wanted to eat for the last 24 hours.

D. Treatments available are-

• Chemotherapy
• Radiation
• Biologic therapy
• Targeted therapy
• Stem cell transplant

In chemotherapy drugs are used to kill the cancer cell.

Then in radiation therapy high-energy X-rays is given to kill leukemia cells or keep them from growing.

In biologic therapy immune system find and attack cancer cells. Drugs like interleukins and interferon can be used to boost body's natural defenses against leukemia.

Targeted therapy uses drugs to block specific genes or proteins that cancer cells need to grow. This treatment can stop the signals that leukemia cells use to grow and divide, cut off their blood supply, or kill them directly.

Stem cell transplant replaces the leukemia cells in bone marrow with new ones that make blood. Doctor can get the new stem cells from patient's own body or from a donor.