1.Master Anoop, 10 years old has been admitted with Acute Myelogenous Leukaemia. Answer the following :
(a) Define Leukaemia. (2)
(b) Write the clinical manifestations of Leukaemia (3)
(c) Write the medical management and the nursing care plan for Master Anoop. (10)
Acute myeloid leukemia
Definition
Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a cancer of the myeloid line of white blood cells.
It is characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow.
The abnormal cells interfere with the production of normal blood cells.
Clinical Manifestations
A lack of normal white blood cell production leads to infections
A lack of red blood cells (anemia) causes :
fatigue
paleness, and
shortness of breath.
A lack of platelets can lead to easy bruising or bleeding with minor trauma. petechiae.
The early signs similar to those of influenza or other common illnesses
loss of appetite
weight loss
bone pain and joint pain
Pain or feeling of fullness below the ribs.
Painless lumps in the neck, underarm, stomach, groin, or other parts of the body - called leukemia cutis, may be blue or purple.
Painless lumps that are sometimes around the eyes called chloromas
An eczema -like skin rash.
Enlargement of the spleen
swelling of the gums because of infiltration of leukemic cells into the gum tissue
Occasionally- no symptoms - discovered incidentally during a routine blood test
Laboratory findings
TC - Very high WBC count - - leukocytosis
Peripheral blood smear : Abnormal white cells - immature cells - myeloblasts
Bone marrow - more than 20% of the blood and/or bone marrow by leukemic myeloblasts
Fluorescent in situ hybridization performed on blood or bone marrow to identify the chromosomal translocation
Medical Management
Chemotherapy
Two phases: induction and postremission (or consolidation) therapy.
Induction therapy to achieve a complete remission
Consolidation therapy to eliminate any residual undetectable disease and achieve a cure.
Iinduction chemotherapy with cytarabine (ara-C) and an anthracycline (such as daunorubicin or idarubicin).
consolidation chemotherapy : allogeneic stem cell transplantation
On relapse -
Cytotoxic drugs such as clofarabine
Targeted therapies such as farnesyl transferase inhibitors, decitabine
Inhibitors of MDR1 (multidrug-resistance protein)
A clinical trial of chemotherapy and ATRA with or without arsenic trioxide.
A clinical trial of a monoclonal antibody with ATRA.
Since treatment options for relapsed AML are so limited, another option which may be offered is palliative care.
Nursing Care plan
Provide care through surgery, radiation therapy, chemotherapy and nuclear medicine processes.
Informing patients about their disease and its treatment
Provide emotional support.
Patient education : advise on what to expect during their stay in the hospital and after they are discharged
Teach them about what drugs they will be taking and the side effects of those drugs, blood transfusions, how to look for signs of infection and bleeding and dietary changes.
Team Nursing and Nursing Documentation improve the quality of care given to patients and their families.
