The purpose of this paper is to briefly describe leukaemia, provide a discussion of the role of the nurses in the early diagnosis, prevention as well as follow up of patients as far as leukaemia is concerned, provide a teaching plan, and identify local resources within the Wilkes-Barre community in Pennsylvania.

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Leukaemia

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Leukaemia

Leukaemia is the word that is commonly used to refer to a set of disorders which involve the increase within blood circulation of immature leucocytes which are known as blasts (Koren and Lishner, 2010). These may also be referred to as haematological neoplasms and are associated with systems such as the circulatory system and the lymphoid system besides organs such as bones (Shapira, Pereg and Lishner, 2008). Leukaemia may be considered a word that describes a broad spectrum of malignancies associated with the immune system cells and organs (Gribben, 2008). The purpose of this paper is to briefly describe leukaemia, provide a discussion of the role of the nurses in the early diagnosis, prevention as well as follow up of patients as far as leukaemia is concerned, provide a teaching plan, and identify local resources within the Wilkes-Barre community in Pennsylvania.

Leukaemia affects more adults in comparison to children with 90% of those diagnosed with the disease being twenty years of age or older. The various types of leukaemia include acute lymphoblastic leukaemia whose subtypes include precursor B acute lymphoblastic leukaemia, precursor T acute lymphoblastic leukaemia, Burkitt’s leukaemia as well as acute biphenotypic leukaemia (Gribben, 2008). Others are chronic lymphocytic leukaemia such as B cell prolymphocytic leukaemia which mostly affects adults and acute myelogenous leukaemia which includes acute promyelocytic leukaemia, acute myeloblastic leukaemia and acute megakaryoblastic leukaemia which affect adults more than children (Miller, Bellizzi and Sufian, 2008). Chronic Myelogenous leukaemia is another kind of leukaemia which mostly affects adults whereas hairy cell leukaemia affects only adult, mostly men (Cannon, et al, 2008). Large granular lymphocytic leukaemia is rare and not as debilitating and adult T cell leukaemia is a result of the human T-lymphotropic virus (HTLV) (Welsh, 2011). Human T-lymphotropic virus (HTLV) is highly prevalent in Japan and moderately prevalent in Africa, Caribbean islands and Nin South America. All these types of leukaemia may be acute or chronic. In most cases of leukaemia, the cause is not always known except in case of Human T-lymphotropic virus (Cannon, et al, 2008). It is thought that exposure to carcinogenic substances and radiation leads to activation of oncogenes or the deactivation of tumour suppressor genes resulting in mutations in DNA (Koren and Lishner, 2010). There is evidence that genetics may play a role in the development of leukaemia as people from the same family sometimes suffer from the same type of leukaemia which has been proven by twin studies as well as family histories (Müller-Staub, et al, 2007). The symptoms of leukaemia include but are not limited to excessive weight loss, fever, frequent and sometimes opportunistic infections, shortness of breath, muscular weakness, ain and tenderness in joints, fatigue, loss of appetite, swelling of lymph nodes, enlargement of liver or spleen, night sweats, easy bleeding and bruising and petechiae among others (Velicer and Ulrich, 2008). These symptoms are normally unspecific as they are associated with a variety of other diseases and confirmation of leukaemia can only be done through the use of complete blood counts and bone marrow examinations which have to be carried out severally (Gribben, 2008). Treatment normally involves chemotherapy, radiotherapy and/ or bone marrow transplant.

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The role of the nurse as far as patients with leukaemia are concerned is to educate them by providing the necessary information, administer drugs, manage the effects of these drugs besides providing support for the patient as well as his or her family. Given the lack of definite physical symptoms as far as leukaemia is concerned, the patient may undergo numerous tests in the course of trying to make a diagnosis. It is the responsibility of the nurse to conduct a nursing assessment which will consist of the subjective and objective information concerning the patient’s condition or complaint. It is also the nurse’s duty to interpret this information and generate a hypothesis which is the possible reasons for the patient’s complaint one of which should be leukaemia in this case (Shapira, Pereg and Lishner, 2008). This should be followed by steps to evaluate these hypotheses and thus eliminate some of them. These steps should consist of relevant laboratory procedures such as bone marrow examinations. Subsequently the nurse should plan or determine the desired patient outcomes and interventions and put the plan into action. Finally, she or he should evaluate the effectiveness of the whole process (Gribben, 2008). Given that the nurse is normally at most contact with the patient, this should be done as soon as the patient makes his or her complaint in order to ensure a speedy diagnosis (Müller-Staub, et al, 2007).

Given that most causes of leukaemia such as carcinogenic substances which are well known, genetic factors and Human T-lymphotropic virus (HTLV) among others are not well known and neither are they within the control of individual, prevention is quite difficult. Additionally, the risk factors for individuals may not be well known. However, education may help individuals that may be at risk for developing leukaemia from carcinogenic substances and carcinogenic substances and Human T-lymphotropic virus (HTLV) (Koren and Lishner, 2010). Education in this case would consist of raising awareness concerning the types of carcinogenic substances such as benzene, irradiation and drugs and how to avoid them. The public may also be educated on how to avoid infection with Human T-lymphotropic virus (HTLV) or how to manage their health if already infected in order for them to receive prompt treatment in case leukaemia develops (Velicer and Ulrich, 2008).

Follow up care is the attention that is given to the patient’s health immediately after the formal treatment at the hospital. The purpose of follow up care in the case of leukaemia is to ensure that the patient does not develop new complications, that the patient does not relapse and thus require readmission, and to ensure that the patient regains their original health if possible. In the case of leukaemia, frequent checkups after treatment is done to ensure that there are no cancer cells that remained in the body after treatment (Shapira, Pereg and Lishner, 2008). The role of the nurse in the follow up of the patient is to counsel the patient and the family and to educate them especially if the patient is returning home. This will enable them to take care of their relative better and to report any changes in need be (Wayne, Baird and Egeler, 2010). Additionally, it will enable the nurse to keep track of the patient’s progress and adherence to procedures such as regular checkups which consist of daily examinations for bleeding and infections as well as bone marrow biopsies every week since the commencement of chemotherapy (Velicer and Ulrich, 2008). Other routine procedures in the follow up of a leukaemia patient include tests for urinary tract infections as well as management of disorders of the nervous system which may be experienced as co morbid disorders. Any other issues which the patients or their families may have is addressed during these follow ups (Gribben, 2008).

In the nursing teaching plan, the details that will be entered include the name of the nurse, the initials of the client, and the age of the client as well as the date. The nursing diagnosis in this case is leukaemia. The learning outcomes for the patient are for him or her to be able to use relaxation techniques in order to decrease anxiety concerning his or her health (Rubnitz, Gibson and Smith, 2010). This will be accomplished through education of the patient concerning how to recognize anxious thoughts and the various techniques that may be used to manage them. The nurse will teach relaxation techniques to the patient such as breathing exercises and meditation towards this end. Evaluation will be done by asking the patient to outline how to recognize anxious thoughts and the methods that may be used to get rid of them. The patient will also be asked to demonstrate these methods of relaxation (Müller-Staub, et al, 2007).

There are no haematologists that are capable of diagnosing leukaemia but there are various activities concerning leukaemia that are ongoing in the region. These include clinical trials of first line treatment of Chronic Myeloid Leukaemia by Geisinger Health system (Shapira, Pereg and Lishner, 2008).

Leukaemia is word that is used in reference to a wide range of malignant disorders affecting the cells of the immune system as well as its organs. Also known as haematological neoplasms, it is more prevalent among adults of twenty years of age and above. The various types of leukaemia that have been mentioned in this study include acute lymphoblastic leukaemia, chronic lymphocytic leukaemia, acute myelogenous leukaemia, chronic myelogenous leukaemia, hairy cell leukaemia, T-cell prolymphocytic leukaemia, large granular lymphocytic leukaemia and Adult T-cell leukaemia. The symptoms of the disorder are not specific to the disease and diagnosis depends on confirmation by techniques such as blood count, bone marrow examination, X-rat, MRI, as well as ultrasound. The role of the nurse in the diagnosis is to: conduct a nursing assessment, interpret the information obtained, generate a hypothesis, take steps to evaluate these hypothesis, plan or determine the desired patient outcomes and interventions, put the plan into action, and evaluate the effectiveness of the whole process. However, given that the causes of majority of leukaemia are known, prevention may be difficult. However, education may be used to enable the public avoid or minimize the risk of being exposed to carcinogens and of being infected with Human T-lymphotropic virus (HTLV) as these two are well known causes of leukaemia. The nurse is also responsible for ensuring that the patient adheres to the routines that take place during follow up in addition to providing information to the patient and his family to ensure the best of care. Additionally, the nurse should address the patient’s concerns as well as the concerns of his or her family during the follow ups. The nursing teaching plan has also been provided in this paper with reference to the nursing outcome, the method through which the learning outcome will be attained as well as the ways through which the patient will be assessed for what he or she has been taught.

References

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Wayne, A., Baird, K., and Egeler, R. (2010). Hematopoietic Stem Cell Transplantation for Leukaemia. Paediatric Clinics of North America. 2010; 57(1).

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