Leukemia is a cancer of the organs that make blood -- the lymph system and the bone marrow. The number of cells produced, the rate at which they are produced, and their ability to function is altered. Acute Lymphocytic Leukemia (ALL) is a rapidly progressing type of leukemia. Blast cells, which are abnormal, do not grow into normal cells. These cells remain immature and are unable to carry out their specific jobs in the body.
Chemotherapy is used for the treatment of ALL and is divided into three phases: induction therapy, central nervous system prophylaxis, and post-remission treatment.
Induction therapy is administered with the attempt to destroy all of the detectable leukemic cells. This is done as an attempt to control the disease in the bone marrow and to prevent the spreading of the disease, especially to the central nervous system. The patient will have to be monitored closely to prevent or reduce the effects of anemia, bleeding, and infection.
The patient may need periodic transfusions with PRBCs to control anemia. Platelets are administered to increase the platelet count and reduce the rate of hemorrhage, allowing treatment to continue. All blood products are to be irradiated if the patient is a candidate for a bone marrow transplant.
Patient education is an important component of all aspects of care because of how symptoms can manifest in ALL patients.
- An elevated temperature is often the only sign of infection since redness, swelling, and pus formation may be absent or delayed due to a lack of white blood cells.
- Older adults may not reveal an elevated temperature, but, rather, a new onset of delirium may present.
- Febrile neutropenia is treated with empiric, broad-spectrum antibiotics.
- Patients need to report chills, fever, sore throat, shortness of breath, and any burning with urination.
Prevention
Prevention is an easy and proactive way patients and their families can avoid infection and other complications.
- Teach patients and caregivers the importance of good hand washing. They should always wash their hands before each meal and after using the bathroom.
- Educate on good personal hygiene with an emphasis on oral care. Recommend a soft toothbrush to brush teeth after meals and at bedtime.
- To avoid constipation, drink plenty of fluids, increase fiber intake, and increase activity if possible.
- Rectal manipulation is to be avoided, including no enemas, no suppositories, no rectal exams, and no rectal temperatures.
- Patients should avoid aspirin and aspirin-like medications, including herbal medications.
- Mouth care supplies provided include peroxide and sterile water. Explain that every four hours while awake the patient should rinse the mouth with one-quarter-strength peroxide and three-quarters-strength sterile water.
To avoid injury in a patient who has thrombocytopenia is important, and the patient should be advised to use electric razors, soft toothbrushes, and stool softeners to decrease straining and prevent bleeding.
Hospitalized patients with a low white blood cell count should be placed on immunocompromised host (ICH) precautions including no fresh fruits or vegetables, and no food containing raw egg whites.
Rules for visitors
Visitors are important; however, there are rules they need to follow to keep ALL patients healthy. Visitors should wash hands when entering the room. Anti-microbial scrub should be placed at the sink’s side. No visitors with a cold or running a fever should be allowed to visit, and no fresh flowers should be allowed in patient rooms.
The importance of taking the above precautions is to help prevent the patient from being exposed to any infectious diseases or viruses. The patients and their families will need to be educated on the severity of being exposed and the symptoms to watch for if there is an exposure. The education for post-treatment care needs to be made available to the patient and to family members.
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