ASSESSMENTGeneralized symptoms: Nausea, pallor, fatigue, generalized lymphadenopathy, fever, malaise, persistent or unexplained bone pain, night sweats, pruritus, unexplained bruising and bleeding, non-blanching rashes, CBC may show abnormally high or abnormally low white blood cell counts. (Brayley, Stanton, Jenner, & Paul, 2019, p. 986 & 988)History from patient/family: Have you noticed or has your child complained of the following: Abnormal bruising or bleeding, bone/joint pain, recurrent or difficult-to-treat infections, increase in tiredness, masses/lumps, shortness of breath on exertion or when lying flat in bed, unexplained fever for >5 days, family history of cancers such as leukemia, genetic abnormalities such as: Down’s syndrome? (Brayley, Stanton, Jenner, & Paul, 2019, p. 988)DIAGNOSISClassic presenting signs and symptoms of Leukemia that warrant further testing are:Anemia, Thrombocytopenia, Pallor, Fever, Recurrent infections, and Bone or Joint pain. (Barbel & Peterson, 2015, p. 32)Initial lab studies which include a CBC with platelet can exhibit high, low, or normal WBC, neutropenia, anemia, and thrombocytopenia. A definitive diagnosis will be made on the basis of a bone marrow biopsy which will show immature blood cells (blasts). (Barbal, Peterson, 2015.p 33)Recommended testing to be performed for diagnosis confirmation: (Arbor et al, 2017, p.1349)CBC with diff and Peripheral blood smear (Arbor et al, 2017, p. 1349)Bone marrow: aspiration, trephine core biopsy, platelet, hemoglobin, and blast percentage (Arbor et al, 2017 p. 1352-1353)Cytogenetic analysis: Karyotype, molecular genetic and FISH testing, flow cytometry panel or immunohistochemical studies for limited immunophenotyping. (Arbor et al, 2017 p. 1358-1359)Lumbar puncture to test cerebrospinal fluid for neurologic involvement (Arbor et al, 2017, p. 1361)Genome and translocation testing (Arbor et al, 2017, p. 1363-1364)Flow cytometry analysis or molecular characterization comprehensive enough to allow detection of MRD. (Minimal residual disease) (Arbor et al, 2017, p. 1363)PLANNINGEducation and transparent communication is vital and will increase success in managing a child diagnosed. It is essential to also provide regular updates on all proceedings for care which will keep families well informed (Brayley, Stanton, Jenner & Paul, 2019, p. 990)Provide information and contact information of specialist centers for care (Brayley et al., 2019, p. 990)Encourage families to establish a working relationship with the child’s school or childcare provider in collaboration with care and concerns (Brayley et al., 2019, p. 990)Educate caregivers to properly and safely care for their child. (e.g. how to avoid infections in central lines and also how to keep it functioning) (Brayley et al., 2019, p. 990)Educate families on when to seek emergency help and/or to manage them. Being aware and prepared for potential complications, adverse reactions, and complications of chemotherapy. (Brayley, Stanton, Jenner & Paul, 2019, p.989)Neutropenic sepsis in patients receiving chemotherapy (Temperature >38° C, Or clinical signs of sepsis); Monitor vital signs and PEWS to avoid deterioration (Brayley et al., 2019, p. 989)Along with being a supportive nurse, coping should be incorporated into patient care to help families manage during this difficult time. Specialist groups/ support groups can provide information, social and psychological support. (Brayley, Stanton, Jenner & Paul, 2019, p. 990)INTERVENTIONSChemotherapy used to stop cancer growth and kill cancer cells in the blood and bone marrow. (Bernard, Abdelsamad, Johnson, Chapman, & Parvathaneni, 2017, p. 2)RadiationX-rays administered in high doses to eradicate cancer cells. (Bernard, Abdelsamad, Johnson, Chapman, & Parvathaneni, 2017, p. 2)treatment based on what type of cancer diagnosed and where the cancer has spread. (Bernard et al., 2017, p. 2)Palliative careTreatment method is used to increase the quality of life, support not only the patient but family as well. (Ghoshal, Salins, Damani, Deodhar & Muckaden, 2016, p. 267)Can be used in conjunction with cancer treatments (eg.chemotherapy). (Ghoshal et al., 2016, p. 268).Symptom management including pain, nausea, fatigue, loss of appetite, anxiety, depression. (Momani, Mandrell, Gattuso, West, Taylor & Hinds 2015, p. 51) EVALUATIONOutcomes for children with leukemia have improved significantly. Successes in pediatric oncology come from a desire to join forces and manage research efforts. Variety in treatment methods allows groups to ask scientific questions and provide opportunities for “innovation and corroboration.” (Zwaan et al., 2015, p. 2)One common complication found upon evaluation is Neutropenia. Chemotherapy increases risk for infections. (Inaba et al., 2016, p. 391)Due to poor cancer related follow up care, 70% of childhood cancer survivors have chronic health conditions as a result of their treatment. (Szalda et al., 2015, p. 342) Limitations in daily activity, cosmetic changes, need for medical equipment/care, or life-threatening late effects. All or most could have been avoided with proper follow up care. (Szalda et al., 2015, p. 342)Childhood cancer is a traumatic experience that affects the lives of all family members. Many of the stresses that accompany childhood cancer have a negative impact on siblings. Providing siblings with appropriate resources will hopefully result in a better adjustment. (Yang, Mu, Sheng, Chen, Hung, 2016, p. 12)ReferencesAburn, G., & Gott, M. (2014). Education Given to Parents of Children Newly Diagnosed with Acute Lymphoblastic Leukemia: The Parent’s Perspective. Pediatric Nursing, 40(5), 243–256. Retrieved from HYPERLINK "http://search.ebscohost.com.ezproxy.lakelandcc.edu/login.aspx?direct=true&db=hch&AN=98978834&site=ehost-live"http://search.ebscohost.com.ezproxy.lakelandcc.edu/login.aspx?direct=true&db=hch&AN=98978834&site=ehost-liveArber, Daniel A., Borowitz, Michael J., Cessna, Melissa, Etzell, Joan, Foucar, Kathryn, Hasserjian, Robert P., Rizzo, J. Douglas, Theil, Karl, Wang, Sa A., Smith, Anthony T., Rumble, R. Bryan, Thomas, Nicole E., Vardiman, James W., (2017). Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Archives of Pathology & Laboratory Medicine, 141(100), pp. 1342-1393. 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