1. General information
    1. Most common form of childhood cancer
    2. Peak incidence is 3 to 5 years of age
    3. Proliferation of abnormal white blood cells that do not mature beyond the blast phase
    4. In the bone marrow, blast cells crowd out healthy white blood cells, red blood cells, and platelets, leading to bone marrow depression
    5. Blast cells also infiltrate other organs, most commonly the liver, spleen, kidneys, and lymph tissue
    6. Symptoms reflect bone marrow failure and associated involvement of other organs
    7. Types of leukemia, based on course of disease and cell morphology
      1. Acute lymphocytic leukemia (ALL)
        1. 80-85% of childhood leukemia
        2. malignant change in the lymphocyte or its precursors
        3. acute onset
        4. 95% chance of obtaining remission with treatment
        5. 75% chance of surviving 5 years or more
        6. prognostic indicators include: initial white blood count (less than 10,000/mm3), child's age (2-9 years), histologic type, sex
      2. Acute nonlymphocytic leukemia (ANLL)
        1. includes granulocytic and monocytic types
        2. 60-80% will obtain remission with treatment
        3. 30-40% cure rate
        4. prognostic indicators less clearly defined
  2. Medical management
    1. Diagnosis: blood studies, bone marrow biopsy
    2. Treatment stages
      1. Induction: intense and potentially life threatening
      2. CNS prophylaxis: to prevent central nervous system disease. Combination of radiation and intrathecal chemotherapy.
      3. Maintenance: chemotherapy for 2 to 3 years.
  3. Assessment findings
    1. Anemia (due to decreased production of RBCs), weakness, pallor, dyspnea
    2. Bleeding (due to decreased platelet production), petechiae, spontaneous bleeding, ecchymoses
    3. Infection (due to decreased WBC production), fever, malaise
    4. Enlarged lymph nodes
    5. Enlarged spleen and liver
    6. Abdominal pain with weight loss and anorexia
    7. Bone pain due to expansion of marrow
  4. Nursing interventions
    1. Provide care for the child receiving chemotherapy and radiation therapy.
    2. Provide support for child/family; needs will change as treatment progresses.
    3. Support child during painful procedures (frequent bone marrow aspirations, lumbar punctures, venipunctures needed).
      1. Use distraction, guided imagery.
      2. Allow child to retain as much control as possible.
      3. Administer sedation prior to procedure as ordered.