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Leukaemia
According to World Health Organization-Europe, 2009 states that in Europe countries, around 2000 the average incidence for this age group was 46.7 cases per million per year, with a slightly lower level in eastern than in western region. Leukaemia is the most common childhood malignancy which accounts for 30% of all cancers diagnosed in children under 15 years of age in industrialized countries. European population-based cancer registries show an average increase in the incidence of childhood leukaemia of 0.7% per year.
Leukemia is cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system. Many types of leukemia exist. Some forms of leukemia are more common in children while other forms of leukemia occur mostly in adults. Leukemia usually involves the white blood cells. White blood cells are potent infection fighters, also known as the soldiers of the body in which they normally grow and divide in an orderly way as the body needs them. But in people with leukemia, the bone marrow produces abnormal white blood cells, which don’t function properly. Common signs and symptoms of Leukemia includes; fever or chills, persistent fatigue, weakness, frequent or severe infections, losing weight, swollen lymph nodes, enlarged liver or spleen, easy bleeding or bruising and bone pain or tenderness as stated by Mayo Foundation for Medical Education and Research, 2017.

Teenage years, specifically the age of 15 is an exciting time of life but also challenging for both teens and the parents. This is because they are being influenced of what they see in television, internet, magazines and this can add to teen’s poor body image. There are four basic areas of teenage development. Firstly, Physical Development. Most teens enters puberty by age of 15. Girls go through a time of rapid growth before their first menstrual period and by age 15, they are near their adult height. Boys usually continue to grow taller and gain weight through their teen years. Secondly, Cognitive development. As they mature, teens are more able to think about and understand abstract ideas such as morality. They also begin to understand other people better. Even though they have a certain amount of empathy and can understand that others have different ideas, they often strongly believe that their own ideas are most true. Thirdly, Emotional and Social Development. Much of teens’ emotional and social growth is about finding their place in the world. They are trying to figure out who they are, where and how to fit in. So it is normal for their emotions to change from day to day. Lastly, Sensory and Motor Development. Boys continue to get stronger, more agile even after puberty and girls tend to level out as stated by Adolescent interest Group, 2013.Getting plenty of exercise helps improve strength and coordination in boys and girls.

According to American Cancer Society, 2017 states that each child getting cancer treatment is unique. The treatments used vary from child to child and from one type of cancer to another, therefore have an impact on the child’s growth and development as well as the whole family. Children who undergoes treatment (surgery, chemotherapy, radiation therapy) may experience cognitive impairment where they could have lower IQ, problems with memory and attention, slowed development and behavioural problems. With the treatments received, not only will that part of the body be affected but other parts as well. Children may have lung problems if they underwent chemotherapy where there is decreased lung volume, may experience shortness of breath, constant cough, increased lung infection may occur and lung tissue may be thickened. May experience Cardiovascular Disease in later years as the heart could be damaged during treatment. This also affects the muscles and growth of bones where there is bone pain, joint stiffness, weak bone and changes in the child walks. The Ears and Eyes can also be affected as there will be poor vision and trouble hearing words. Children may experience delayed tooth development, increased risk of cavities and Gum disease. The sexual developments are affected where there is decreased in production of sperms in males and ovaries been affected by radiation and chemotherapy in females therefore decreased in fertility for both .Slow growth is a problem in childhood cancer treatment. For the family, they may face financially constraints in supporting the child, that is to take the child to hospital every now and then for the child’s clinic and treatment. They may think that the child is a burden to them and definitely some parents are very stressful since they are caring for the ‘sick’ child.

The literature reviewed on the problem is that Leukaemia is the most common type of cancer which accounts for 30% of all cancers diagnosed in children younger than 15 years. It states that child leukaemia has been related to external factors to which children are exposed to. The only environmental risk factor which is ionizing radiation was significantly linked to leukaemia in children. (http://www.hsj.gr/abstract/risk-factors-for-childhood-leukemia-a-comprehensive-literature-review-3192.html). Other study states that treatment options have great impact on children’s weight, appetite and decreased in mineral and bone density while other study in the Pacific island countries states that cancer was among the leading causes of deaths; thus they now experience a double burden of cancers linked to infections and life-style and reproductive factors.

There are essential use of strategies the Nurse can use in caring for the child and families with Leukemia. The nurse can conduct patient and family education during family conference which will be based on learning activities with child and family and reflect on the difference between acute and chronic leukemia with symptoms presented to health facility. The nurse can elaborate on the developmental and health status of the child and teach the family on how the child could be infection free with monitoring of body temperatures. The nurse plays the role of an Advocator while receiving treatment in hospital with accurate information in regards to the disease is relayed to the child and families and also negotiate within the health care system to meet their care needs. Providing a supportive presence and monitoring and anticipation. With this the nurse informs the child and family that they are not alone and of course to listen to them non judgmentally to expressions of anger, distress and fear. The nurse can monitor vital signs and knows the vulnerable time points such as the expected number of neutrophils. (Nazari et al., 2016)
Nursing Care Plan for Leukaemia Child
Problem Planning Intervention Outcome
Risk of Infection To reduce the risk of infection.

Sterile technique is strictly followed
Isolate child Child with IV cannula should be changed every 3 days
Practice sterile technique while doing procedures such as administering IV medications.

Limit visitors- protect the child from potential source of pathogens.

All equipment’s use should be sterilized Child with Leukaemia is infection free
Elevated white blood cell count(WBC) Monitor vital signs
Frequently check updated blood results Check BP, temperature, respiration rate every 8 hours
Do full blood screening
May infuse blood (BTF) if needed.

Sponge patient if temperature is high. White blood cell is maintained within normal level.

Maintain normal body temperature.

Pain Monitor pain
Decrease stressful stimuli
Limit/decrease noise, lightening and constant interruption
Provide a quiet environment Monitor pain using the pain scale as this may indicate developing complications.

Monitor vital signs
May administer opioids if prescribed
May engage child to read books or listening to music.

Demonstrate behaviours to alleviate pain Pain is alleviated
Able to sleep and relaxed appropriately.

Deficient fluid volume Monitor output and input
Daily weight check
Monitor HR &BP Record input and output Q2hly.

Encourage fluids intake up to 3-4L per day
Encourage oral hydration & high residue diet
Administer IV fluids as indicated Efficient fluid volume in the body
Constipation is prevented
Maintain electrolyte balance
Activity Intolerance Sit with child and schedule daily or alternate days for physical activity Provide quiet environment & uninterrupted rest periods
Implement energy saving techniques e.g. sitting
Recommend small, nutritious with highly protein diet Decrease fatigue on a child
Able to do some physical activities
Teaching Plan
Child Family
To prevent infection-wash your hands often, avoid people who are sick
To prevent bleeding and bruising-use an electric razor to shave, do not play contact sports such as football, use soft toothbrush, do not floss teeth, blow nose gently and be careful with sharp objects
Don’t go near people who smokes
May need to drink extra liquids to prevent dehydration
Exercise as directed to have more energy
Eat healthy foods that’s rich in protein Supervise child while taking medication.i.e taking right medication with right dose on the right time
Always alert at all times while taking care of leukaemia child at home
Seek medical care and advice if the child;
Has the body temperature over 38 degrees Celsius
Bleeding from the nose, gums or any oriphisesHas difficulty eating or drinking
Has difficulty passing urine
Unable to have bowel motion for three days
Has vomiting/diarrhoea for more than six hours
Has skin rash
To Conclude, In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA. There may be other changes in the cells that have yet to be fully understood that could contribute to leukemia. Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia.

REFERENCES:
Armstrong GT, Liu Q, Yasui Y, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. Journal of Clinical Oncology.Retrievedfromhttp://www.euro.who.int/__data/assets/pdf_file/0005/97016/4.1.-Incidence-of-childhood-leukaemia-EDITED_layouted.pdfBansal D, Shava U, Varma N,(2012). Imatinib has adverse effect on growth in children with chronic myeloid leukemia. Pediatric Blood Cancer.
Nazari, S., Malek, F., Zavar, N, (2016) Cancer Lineage Switch in Childhood Leukemia: A Case Report and Review of Literature Iranian journal of Blood & Cancer. Retrieved from http://ijbc.ir/article-1-688-en.pdf.

Mayo Foundation for Medical Education and Research (2017). Retrieved from. (https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373
Pui, H.C (2012). Childhood Leukaemia (3rd Ed.). St Jude’s Children Research Hospital
Retrieved from https://www.drugs.com/cg/acute-lymphocytic-leukemia-discharge-care.htmlRetrieved from http://ijp.mums.ac.ir/article_3869_581.html
Retrieved from https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373
Retrieved from https://www.webmd.com/children/tc/growth-and-development-ages-15-to-18-years-topic-overview#1
Retrieved from https://nurseslabs.com/5-leukemia-nursing-care-plans/4/

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