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Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, refers to an abnormal growth of lymphocyte precursors or lymphoblasts. What is Acute Lymphocytic Leukemia?Acute leukemias have large numbers of immature leukocytes and overproduction of cells in the blast stage of maturation.
PathophysiologyPathogenesis isn’t clearly understood, but the pathophysiology may be explained by the following:
Statistics and IncidencesOne of the most common forms of acute leukemia is acute lymphocytic leukemia.
CausesResearch on predisposing factors isn’t conclusive but points to some combination of viruses, immunologic factors, genetic factors, and exposure to radiation and certain chemicals.
Clinical ManifestationsSigns of acute lymphocytic leukemia may be gradual or abrupt.
ComplicationsUntreated, acute leukemia is invariably fatal, usually because of complications that result from leukemic cell infiltration of the bone marrow and vital organs.
Assessment and Diagnostic FindingsThe diagnosis of ALL can be confirmed with a combination of the following:
Medical ManagementWith treatment, the prognosis varies.
Pharmacologic TherapyALL chemotherapy includes the following drugs and also other drugs included in the treatment:
Surgical ManagementAggressive treatment may include surgical management through:
Nursing ManagementThe 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. Nursing AssessmentThe clinical picture varies with the type pf leukemia as well as the treatment implemented, so the following must be assessed:
Nursing DiagnosisBased on the assessment data, major nursing diagnoses for the patient with ALL may include:
Nursing Care Planning & GoalsMain Article: 5 Leukemia Nursing Care Plans The major goals for the patient may include:
Nursing InterventionsThe interventions included in the care plan of the patient follows. Before treatment:
Plan meticulous, supportive care:
EvaluationExpected patient outcomes may include:
Discharge and Home Care GuidelinesMost patients cope better when they have an understanding of what is happening to them.
Documentation GuidelinesThe focus of documentation should include:
Practice Test: Acute Lymphocytic LeukemiaHere are some practice questions for this study guide. Please visit our nursing test bank page for more NCLEX practice questions. 1. Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia? A. Instituting infection control precautions. B. Encouraging adequate intake of iron-rich foods. C. Assisting with coping with chronic illness. D. Administering medications via IM injections. 1. Answer: A. Instituting infection control precautions. Acute lymphocytic leukemia (ALL) causes leukopenia, resulting in immunosuppression and increasing the risk of infection, a leading cause of death in children with ALL, therefore, the initial priority nursing intervention would be to institute infection control precautions to decrease the risk of infection.
2. Which of the following complications are three main consequences of leukemia? A. Bone deformities, spherocytosis, and infection. D. Polycythemia, decreased clotting time, and infection. 2. Answer: B. Anemia, infection, and bleeding tendencies. The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production.
3. A client with leukemia has neutropenia. Which of the following functions must be frequently assessed? A. Blood pressure. B. Bowel sounds. C. Heart sounds. D. Breath sounds. 3. Answer: D. Breath sounds. Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required.
4. A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia? A. Abdominal pain. B. Increased activity level. C. Increased appetite. D. Petechiae. 4. Answer: D. Petechiae. The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain.
5. What are the three most important prognostic factors in determining long-term survival for children with acute leukemia? A. Histologic type of disease, initial platelet count, and type of treatment. B. Type of treatment and client’s sex. C. Histologic type of disease, initial WBC count, and client’s age at diagnosis. D. Progression of illness, WBC at the time of diagnosis, and client’s age at the time of diagnosis. 5. Answer: C. Histologic type of disease, initial WBC count, and client’s age at diagnosis. The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia.
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