Module 09 Discussion-Overcoming Challenges

Lymphoblastic Leukemia

Lymphoblastic leukemia is a disorder that is most common in children. It is a malignancy that is associated with the b-lymphoblasts. Pathologically, the immature and abnormal lymphocytes undergo an uncontrolled proliferation process (Hunger & Mullighan., 2015). The progenitors of these lymphocytes also undergo proliferation, replacing other lymph organs and the elements of bone marrow. The clinical presentations associated with this malignancy include anemia, neutropenia, and cytopenia since the tumor replaces the bone marrow. The intervention strategies are aimed at correcting the primary pathophysiology of proliferation of these progenitors, immature and abnormal cells. The treatment also involves the management of clinical manifestations such as infections, bleeding, and weight loss.

The treatment strategies include chemotherapy, stem cell transplant, and radiation therapy. Chemotherapy involves the administration of drugs for remission purposes (Bongiovanni et al., 2017). This is done in three different phases, which include the induction phase, consolidation phase, and central nervous system therapy. These drugs have strong and adverse effects on the person receiving chemotherapy. Some of these side effects include excessive weight loss.

Stem cell transplants and bone marrow transplants can be done on patients with lymphoblastic leukemia. A bone marrow transplant is the replacement of one’s defective bone marrow elements with a healthy one. So that the body does not reject and react to the donor’s stem cells, immunity suppression is done. Immune suppression weakens one’s immune system (Kruth et al., 2017). Once with a weakened immune system, they are likely to get infected and develop septicemia. A nurse should, therefore exercise infection control for patients who have had stem cell transplants. Sepsis in a weakened immune system is highly associated with death in hospital institutions. Infection control is important during nursing care.

Some of the nursing interventions for the prevention of infection in immune-suppressed patients include placing them in private rooms to minimize hospital-acquired infections. The nurses can also minimize the number of visitors who visit these patients. Those allowed to visit must have their blood samples checked in the laboratory, ensuring they do not have any infection. Live flowers or plants should not be allowed into the rooms of these patients. This is because these pollens have a chance of causing an allergic reaction in these patients. Cross-contamination is another challenge experienced during the nursing intervention. Personnel or staff working in rooms with infectious diseases should not come in contact with patients who have had chemotherapy and stem cell therapy. Adhering to the handwashing protocols in the hospital set-ups helps to minimize the risks of infections.

Skincare intervention is also key when managing these patients. Any wound breakages and wound ulcers are likely to compromise her healing. Skin breakages are a portal entry of potentially harmful pathogens. Chemotherapy involves the administration of strong medications that are likely to cause excessive fatigue and other severe adverse effects, making the patient bedridden. A bedridden patient is at risk of developing pressure ulcers on the bony prominence. A nurse should therefore strive to minimize any invasive procedures, including injections. Chemotherapy and weight loss are also closely related. Therefore, good nutrition is an important aspect of care. Despite fastening any wound healing, it improves the immunity of the patient’s immunity through weight increment. The patient should be encouraged to eat food with high calories and proteins.

Radiation therapy is the exposure of the affected bone marrow to radiation to arrest the proliferation process. Even though this intervention technique is feasible, it has its challenges. These include cases of hair loss, vomiting, diarrhea, skin changes, and sexual and fertility problems. These problems can lead to mental illnesses and psychological instability (Petrykey et al., 2019). Therefore nurses should be at the front line in providing psychological support to these patients. This helps to improve the efficacy of the treatment and the general health outcome of the patient. There is also the need to involve the multidisciplinary team during the entire management process.

References

Hunger, S. P., & Mullighan, C. G. (2015). Acute lymphoblastic leukemia in children. New England Journal of Medicine, 373(16), 1541-1552. https://www.nejm.org/doi/full/10.1056/NEJMra1400972

Kruth, K. A., Fang, M., Shelton, D. N., Abu-Halawa, O., Mahling, R., Yang, H., … & Pufall, M. A. (2017). Suppression of B-cell development genes is key to glucocorticoid efficacy in treatment of acute lymphoblastic leukemia. Blood, The Journal of the American Society of Hematology, 129(22), 3000-3008. https://ashpublications.org/blood/article/129/22/3000/36066/Suppression-of-B-cell-development-genes-is-key-to

Bongiovanni, D., Saccomani, V., & Piovan, E. (2017). Aberrant signaling pathways in T-cell acute lymphoblastic leukemia. International journal of molecular sciences, 18(9), 1904. https://www.mdpi.com/1422-0067/18/9/1904

Petrykey, K., Lippé, S., Robaey, P., Sultan, S., Laniel, J., Drouin, S., … & Krajinovic, M. (2019). Influence of genetic factors on long-term treatment related neurocognitive complications, and on anxiety and depression in survivors of childhood acute lymphoblastic leukemia: The Petale study. PloS one, 14(6), e0217314. https://doi.org/10.1371/journal.pone.0217314

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