Paper Example on Leukemia: Immature White Blood Cells Overrunning Healthy Cells

Introduction

Leukemia is an increase in the white blood cell antecedents in the bone marrow or the lymph tissues and buildup in the body tissues, peripheral blood, and the bone marrow. All the blood components originate from the bones marrow such as cranium, sternum, and the iliac crest. The blood cells arise as immature cells that later differentiate into red blood cells, platelets, and various forms of white blood cells. A leukemia condition develops when immature white blood cells crowd out the healthy developing cells. When healthy cells are substituted by leukemic cells, thrombocytopenia, anemia, and neutropenia may occur. Perfusion is the passage of fluid through the lymphatic or the circulatory system to a tissue or an organ. It is usually referred to as the delivery of blood to an organ of a particular place. The essay shall discuss the effects of leukemia treatment in the perfusion in children. Chemotherapy is the primary treatment of leukemia; however, it affects the passage of body fluids causing retention in the organs, which might be a source of perfusion defects in children.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Treatment of leukemia involves a variety of practices which include chemotherapy; the most significant form of treatment, biological therapy, stem cell transplant, radiation therapy, among others. The most common type of childhood leukemia treatment is chemotherapy. However, stem cell transplant may be combined with high- dose chemotherapy on high-risk leukemia (Bertha, Candelaria, Gallegos, Gytan, & Zamudio, 2016). Chemotherapy is one of the commonly used methods of treatment in children. The major types of acute childhood leukemia are acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). The two illnesses are treated using chemotherapy since it is the standard form of treatment in these types of cancers.

Acute Lymphoblastic Leukemia

Assessment of the disease

In this type of cancer, the cells of a child fail to function normally as in normal lymphocytes. Thus they are unable to fight infections. However, the increase in leukemia cells reduces the room for the healthy red blood cells, platelets, and white blood cells. This condition might lead to conditions such as anemia and bleeding easily. ALL in children is caused by various risk factors which include exposure to x-rays before birth, exposure to radiation, previous chemotherapy treatment, changes in the genes or chromosomes, and various genetic problems such as Bloom syndrome and Fanconi anemia (Bertha, Candelaria, Gallegos, Gytan, & Zamudio, 2016). The main symptoms of this illness include fever, bruising, joint or bone pains, pain below the ribs, loss of appetite, and weakness.

Diagnoses

There are several tests and procedures followed to diagnose childhood ALL. The tests done are meant to find out the spread of leukemic cells to other organs of the body like the testicles and the brain. Physical examination is done by observing the significant signs of ALL such as bruises, lumps, and all other conditions that look abnormal. It is followed by a complete blood count (CBC) where a blood sample is drawn and checked for the number of red blood cells and platelets, the type and the number of white blood cells, the level of haemoglobin in the red blood cells, and the area made up by these RBCs (Salazar et al. 2012). Other tests include blood chemistry studies where a blood sample is drawn from the body, and it is checked on the number of substances released into the blood by various organs and tissues. More so, a bone marrow biopsy may be done by removing the bone marrow and tiny pieces of bones by inserting a needle into the hip or breast bone.

Based on data obtained from the assessments, the primary nursing diagnoses include, risk of infection where there is a related overproduction of immature red blood cells. The patient also might have the chance of weakened skin integrity, which is connected to nutritional alterations, and reduced immobility. The patient might also be having acute pains due to leukocyte infiltration of systemic tissues, and fever. Moreover, the patient may have activity intolerance and fatigue as a result of anemia caused by ALL.

Planning

The care plan for patients with leukemia should be accentuated on coziness to minimise the risks associated with chemotherapy treatment, to manage complications, and to prevent damage of veins. The nurses should also offer psychological support and teachings. The treatment options are appropriately chosen depending on the age of the child (Melisa, Ness, Gurney, et al. 2013). The most appropriate nursing care plan for a child with leukemia includes ensuring that pain is absent, the child is provided with adequate nutrition, the child can tolerate the whole treatment activity, the ability of the child to cope with the diagnosis and treatment as well as the ability for self-care. The nurse should also portray a positive body image to the child. Proper plans of care improve the wellness of the child, which also enhances their healing process.

Interventions

The interventions during childhood leukemia treatment can be grouped into two; before treatment, and supportive care. Before treatment, the nurse should explain the disease, the treatment, and the adverse effects of the primary treatment. The overall nursing intervention before treatment involves educating the parents and the child on how to identify the possible symptoms of ALL occurrences. Chemotherapy treatment causes loss of weight and anorexia; thus; the nurse should ensure that patients are given high-calorie and high-protein food and beverages. More so, the nurse should establish an important recovery program for the patient during remission.

Supportive care involves watching out for meningeal leukemia, which causes confusion, headaches and fatigue. Nurses should know to manage the care after intrathecal treatment. The nurse should give allopurinol, acetazolamide and sodium bicarbonate drugs to prevent hyperuricemia, which is caused by rapid chemotherapy-induced leukemia cell division by encouraging fluids to 2000ml every day. They should place the patient in a private room and institute proper neutropenic safety measures (Bertha, Candelaria, Gallegos, Gytan, & Zamudio, 2016). The patient skin and the perianal area should be kept clean by applying slight lotions and creams to prevent the skin from cracking and drying. However, cleaning of the skin should be done before all the other invasive skin procedures. Providing sufficient hydration and high residue diet, stool softeners, and encouraging the patient to walk helps to prevent constipation (Melisa, Ness, Gurney, et al. 2013). Routine mouth care and saline rinses help to prevent mouth ulcers and gum swelling. Finally, the nurse should give psychological to the patient by establishing excellent communication, which builds a trusting relationship. The patient should also be provided with a calm and quiet atmosphere to manage their stress.

Evaluation

Evaluation involves the expected results in the whole treatment process. The patient should show no evidence of infection and experience no bleeding. This indicates that the recovery process has been successful. More so, the patient should attain the optimal level of nutrition, and show satisfaction with the pain and the relaxation levels. Successful treatment can also be indicated by reduced fatigue, and improved physical activities, absence of complications, and smooth coping with anxiety and pain.

Effects of Childhood Leukemia Treatment on Perfusion

Treatment of childhood Leukemia can cause perfusion defects in the brain of a child as observed by SPECT tests. In a study performed compare SPECT images on perfusion and MRI in patients treated with ALL, the results obtained indicated that about 30% of children treated shown small defects in the cerebral blood volume (Pu et al. 2014). However, the fault is minor since the MRI images did not observe it. SPECT is the most suitable method of investigating brain perfusion in children since it does not require sedation as it is painless and noninvasive. Most of the drugs used during ALL treatment do not pass through the blood-brain barrier, which suggests that they are not responsible for the defects observed. However, methotrexate, a drug used during chemotherapy treatment of Leukemia, passes the blood-brain barrier, which can be the causes of the defects found by SPECT. Abnormalities in brain perfusion cause confusion, seizures, and drowsiness. High doses of methotrexate cause depression of cerebral glucose metabolism, which results in changes in the white matter of the brain as observed in MRI of the brain.

The knowledge behind the neurotoxicity of methotrexate is not well defined, but it has been thought to disturb two major metabolic pathways in the central nervous system. First, it impedes dihydrofolate reductase thus depleting the cells of its novo synthesis of purine nucleotides and thymidylate (Salazar et al. 2012). Secondly, it inhibits dihydropteridine reductase, therefore, inhibiting tetrahydrobiopterin synthesis, which is the primary step of biogenic synthesis of amine. Most biogenic amines are vasoactive and are capable of altering the tone of the blood vessels of the brain, which may, in turn, alter brain perfusion. More so, methotrexate has a direct toxic effect on blood vessels as it damages the endothelial cells.

Chronic exposure to intravenous methotrexate which is usually combined with intrathecal methotrexate during ALL treatment explains the perfusion defects in children as seen by the consequences of a regular decrease in the local cerebral blood flow (Melisa, Ness, Gurney, et al. 2013). This frequent administration of the drugs does not give the brain time to recover. Therefore, these findings indicate that children treated with intravenous methotrexate and intrathecal methotrexate have a risk of neurotoxicity. Methotrexate chemotherapy may be the most suitable treatment of Acute Lymphoblastic Leukemia, although it induces toxicity into the brain, which affects the cerebral blood volume and other complications.

Conclusion

In conclusion, childhood leukemia can be in the form of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Their treatment involves a variety of interventions, but Chemotherapy is the most suitable type of treatment among children. Chemotherapy consists of the use of several drugs that are administered to the central nervous system. Use of intravenous methotrexate which is usually combined with intrathecal methotrexate induces toxicity in the brain of a child which affects the volume of the cerebral blood and the normal flow of the cerebral fluid casing perfusion defects such as seizure, confusion and drowsiness. Therefore, treatment of childhood leukaemia with methotrexate causes perfusion defects in the brain of the children, which might affect their daily development process.

References

Bertha, A., Candelaria, M., Gallegos, J., Gytan, D., & Zamudio, J.J. (2016). Acute Lymphoblastic Leukemia in Children: NANDA, NIC-NOC Care-Givers Intervention. [Online]. Available from: http://dx.doi.org/10.5430/jnep.v6n7p31.

Melissa, M.H., Ness, K.K., Gurney J.G., et al. (2013). Clinical Ascertainment of Health Outcomes Among Adults Treated for Childhood Cancer. JAMA. doi:10.1001/jama.2013.6296.

Pui, C.H., Pei, D., Campana, D., Cheng, C., Sandlund, J.T., Bowman, W.P...Hudson, M.M. (2014). A Revised Definition for Cure of Childhood Acute Lymphoblastic Leukemia. Macmillan Publishers.

Salazar, J., Altes, A., Rio, E., Estella, J., Rives, S., Tasco, M... Navajas, A. (2012). Methotrexate Consolidation Treatment According to Pharmacogenetics of MTHFR Ameliorates Event-Free Survival in Childhood Acute Lymphoblastic Leukemia. The Pharmacogenomics Journal. Macmillan...