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Discuss about the Thorough Review On Lymphoblastic Leukemia.

Lymphoblastic Leukemia

Comprehensive view

Referred medical unit


Detection of disease

Lymphoblastic Leukemia is a critical disease that increases the quantity of white blood cells count in the body. It generally affects the bone marrow and blood in the body. The disease causes a depletion in the blood cell production and leads to anaemia and neutropenia. A bone marrow that produces lymphocytes faces a malignant modification in this disease (DeSantis et al 2014).  

Department of Oncology has to be referred


·         Exhaustion and tiredness

·         Reduction in weight

·         Lack of appetite

·         Muscles become unduly sensitive and responsive

·         Fluctuation in mood

·         Aches in the joints of the body

·         The skin tone lacks the natural colour and becomes pale

Physical Changes

·         The patient pulse is often fluctuating and a quivering is seen in the patient

·         -the skin tone loses its natural colour and becomes pale and whitish.  

Diagnosis of total Blood count: the complete blood count will verify the various types of blood cells present in the body. In the mentioned disease, the production of white blood cells increase in a huge quantity and the production of red blood cell in reduced.

Detection of white blood cells production: the white blood cell count will help to detect the presence of leukemia in the body. A high rate of white blood cell will determine that the patient is suffering from the disease (Brentjens et al. 2013).

The patient will suffer a high uric acid in the body. The uric acid test also determines the existence of the disease.

The patient undergoes x-ray tests to detect if there is any nodes or humor is present in the patient.

The bone marrow biopsy is done to detect the mature and immature cells in the patient’s body (O'Brien et al.2014).

Chances of Infection

Related to: steps taken that might make a behavioural change in the wbc count in the body

Expected outcome: precaution from infection and healing of the patient.

Necessary steps:


The visitors must maintain a proper hygiene before and after visiting the patient. Using of hand sanitizer and hand wash by the visitors and the patient is must.

The chances of infection and contamination becomes less.

The patient’s temperature must be observed regularly and any change in blood pressure, temperature or cardiac unrest detected must be consulted to the doctor. 

Temperature fluctuation is a common post effect of chemotherapy but cardiac unrest or hyperthermia is directly related to infection.

Offensive or unhealthy work or lifestyle should be avoided.

Irregular lifestyle or unhealthy surroundings might enhance the growth of deadly germs and bacteria’s causing infection. Proper hygiene should be maintained to avoid such situation.

The patient must undergo regular x-ray test

Regular monitoring will help to identify the chances of respiratory problem in the patient.

Medicines like ofloxacin and rifampin can be provided.

Given to the patient for prevention or treatment of the disease.

The basic treatment for such disease is chemotherapy and stem cell transplant.

These treatments are the basic treatments for such diseases.

Pain in the body

Related to: the organs and lymph nodes becomes large in the patient’s body as they get entact with leukemic cells.

Desired outcome: The patient feedback is required about the pain. The patient must have a proper sleep and relaxed lifestyle.

Necessary steps:


The pain in the patient’s body must be monitored with a elevation scale to track the increase or decrease in the pain.

The rate of pain can determine the complicacy of the disease and required steps can also be taken on that basis.

The patient must be kept stress free and  relaxed.

The patient must lead a stress free life leading to a better quality of life.

Usage of comfort objects should beencouraged, example- pillow.

It helps to give comfort and relaxation in the joints of the patient.

Medicines like analgesics can be given to the patient

The patient is relieved from the pain.

The patient can be involved in entertaining activities.

It will help the patient to get diverted to other topic and forget about the pain.

Mental issues faced by the Patient

Related to: General weaknesses attributed to enhanced metabolic rate as a result of increased production of leukocytes and imbalance between management and hypoxia

Desired outcome: To enhance activity tolerance and enhance participation in ADLs.

Necessary steps:


It is necessary to measure the level of tiredness and fatigue in the patient. A track must be kept on the patient’s capacity to continue the activities of daily life.

A constant treatment of chemotherapy, leukemia can make the patient weak and tired to maintain the regular lifestyle.

The patient must be provided with an environment that gives him/her mental and environmental peace.

The environmental peace provides relaxation and energy to the patient.

Regular blood test is necessary

It is important to keep a note on the level of anaemia and accordingly necessary steps can also be taken.

Patients Education about the disease.

Related to: Patients lacking proper information about the treatment

Desired outcome: The patient becomes well aware about the side effects and co operates with the medical team.

Necessary steps:


A regular test and review on the patient’s condition is very important.

Continuous therapies and personal activities can enhance the treatment and improve the patient condition.

Importance of chemotherapy

It is an effective treatment for people suffering from leukemia (Doenges,Moorhouse and Murr 2013).

Discussing the remedies and side effects of the therapy

It is necessary to inform the patient about the side effects of the therapy. Few common effects are vomiting, hair loss, weakness. The management can get prepared for such effects if informed earlier (Rossi et al. 2013).

Issues related to Fluid intake

Related to: Other illness faced by the patient during the treatment period

Desired outcome: The patient will be able to recover from dehydration.  

Necessary steps:


A regular check on the food and fluid intake must be noted. There must be balanced food intake and output of the patient.

If the uric acid is noted to be higher then it means the kidneys of the patient are effected and necessary steps has to be taken.

Daily blood pressure and pulse rate has to be measured.

The regular monitoring helps to keep a track if the patient is suffering from dehydration or not.

The patient must intake 4 litre of fluid daily.

Intake of sufficient fluid helps to clear the medicines and regulate the urinary system with a proper outflow of urine.

It is better to mouth wash to maintain a good oral health.

There are chances of gum bleeding for the patient if brushed, mild brushing can also lead to bleeding so it is better to only mouth wash.

Intravenous fluids can be used by the patient

During dehydration when the patient is unable to consume any food they must intake IV fluids to maintain the electrolyte balance in the body.

Monitoring of red blood cells

The blood test can determine the requirement of blood in the patient body to cure anaemia (Eichhorst et al.2015).

Mental distress faced by the patient

Related to: The behavioural changes seen in the patient due the treatment procedure.

Desired outcome: The patient will be relaxed from the side effects and co operate with the medical team and families during the treatment period.

Necessary steps:


The patient behavioural must be considered. If the patient is distressed or offensive it must be noted.

During the treatment period the patients tends to become defensive and distressed.

A feeling of trust and empathy should be provided to the patient.

The patient is generally in distress but a act of empathy and care can cure the distress from the patient (Drozdowicz and Bostwick 2014).

The families and friends are advised to support the patient with care and empathy.

When dear ones are surrounded management treats the patient with extra care and love, the patient feels less distressed and anxious (Burger et al. 2015).

The patient can opt for entertainment like watching televisions and listening to music to feel better.

Entertainment can play a vital role to reduce the patients stress and anxiety (Vora 2017).

After treatment Recommendation:

 It is important for the patient family to be aware of the aftercare steps of the patient family. The family will be provided with the necessary information and interventions that the family must know. The patient must visit the physician for a regular check up to keep a track on the healing process. The patient family should be presented and explained the necessary care the family must take. A well maintained diet and medication has to be maintained by the patient. Lastly, a telephone calling option must be provided to the patient family for any emergency purpose.


Brentjens, R.J., Davila, M.L., Riviere, I., Park, J., Wang, X., Cowell, L.G., Bartido, S., Stefanski, J., Taylor, C., Olszewska, M. and Borquez-Ojeda, O., 2013. CD19-targeted T cells rapidly induce molecular remissions in adults with chemotherapy-refractory acute lymphoblastic leukemia. Science translational medicine, 5(177), pp.177ra38-177ra38.

Burger, J.A., Tedeschi, A., Barr, P.M., Robak, T., Owen, C., Ghia, P., Bairey, O., Hillmen, P., Bartlett, N.L., Li, J. and Simpson, D., 2015. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. New England Journal of Medicine, 373(25), pp.2425-2437.

DeSantis, C.E., Lin, C.C., Mariotto, A.B., Siegel, R.L., Stein, K.D., Kramer, J.L., Alteri, R., Robbins, A.S. and Jemal, A., 2014. Cancer treatment and survivorship statistics, 2014. CA: a cancer journal for clinicians, 64(4), pp.252-271.

Doenges, ME, Moorhouse, MF & Murr, AC 2013, Nurse's pocket guide: diagnoses, prioritized interventions, and rationales, 13th edn, FA Davis, Philadelphia, USA.

Drozdowicz, L.B. and Bostwick, J.M., 2014, June. Psychiatric adverse effects of pediatric corticosteroid use. In Mayo Clinic Proceedings (Vol. 89, No. 6, pp. 817-834). Elsevier.

Eichhorst, B., Robak, T., Montserrat, E., Ghia, P., Hillmen, P., Hallek, M. and Buske, C., 2015. Chronic lymphocytic management: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 26(suppl_5), pp.v78-v84.

O'Brien, S., Furman, R.R., Coutre, S.E., Sharman, J.P., Burger, J.A., Blum, K.A., Grant, B., Richards, D.A., Coleman, M., Wierda, W.G. and Jones, J.A., 2014. Ibrutinib as initial therapy for elderly patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma: an open-label, multicentre, phase 1b/2 trial. The lancet oncology, 15(1), pp.48-58.

Rossi, D., Rasi, S., Spina, V., Bruscaggin, A., Monti, S., Ciardullo, C., Deambrogi, C., Khiabanian, H., Serra, R., Bertoni, F. and Forconi, F., 2013. Integrated mutational and cytogenetic analysis identifies new prognostic subgroups in chronic lymphocytic leukemia. Blood, 121(8), pp.1403-1412.

Vora, A 2017, Childhood acute lymphoblastic leukemia, Springer, Cham.

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