NCLEX Review Guide: Pediatric Leukemia

Acute Lymphoblastic Leukemia (ALL)

• Most common childhood cancer, accounting for 80% of pediatric leukemias with peak incidence at ages 2-5 years
• Malignant proliferation of immature lymphoblasts that crowd out normal blood cells in bone marrow
• Better prognosis than AML with 5-year survival rates exceeding 90% in children

Acute Myeloid Leukemia (AML)

• Less common but more aggressive form affecting myeloid cell lines (granulocytes, monocytes, platelets, RBCs)
• Often associated with genetic disorders like Down syndrome and previous chemotherapy exposure

Signs and Symptoms

• Fatigue, pallor, and weakness due to anemia from decreased RBC production
• Frequent infections and fever from neutropenia and immunosuppression
• Easy bruising, petechiae, and bleeding from thrombocytopenia
• Bone and joint pain from leukemic cell infiltration into bone marrow
• Lymphadenopathy and hepatosplenomegaly from organ infiltration

Infection Prevention

1. Monitor for signs of infection including temperature >100.4°F (38°C)
2. Implement protective isolation precautions and limit visitors
3. Provide meticulous oral care and assess for mucositis
4. Avoid rectal temperatures, suppositories, and invasive procedures when possible

Bleeding Precautions

• Monitor platelet count and implement bleeding precautions when platelets <50,000/mm³
• Use soft-bristled toothbrush and avoid flossing to prevent gingival bleeding
• Apply pressure to injection sites for extended periods and avoid IM injections
• Assess for internal bleeding including headaches, vision changes, and abdominal pain

Treatment Phases

1. Induction therapy: Achieve remission (usually 4-6 weeks)
2. Consolidation therapy: Eliminate remaining leukemic cells
3. Maintenance therapy: Prevent relapse (can last 2-3 years)

Common Chemotherapy Side Effects

• Nausea and vomiting: Administer antiemetics prophylactically before chemotherapy
• Mucositis: Provide frequent oral care with normal saline rinses
• Alopecia: Prepare child and family, discuss wigs or head coverings
• Tumor lysis syndrome: Monitor for hyperkalemia, hyperphosphatemia, and hyperuricemia

Discharge Teaching

• Teach parents to recognize signs of infection and when to contact healthcare provider immediately
• Emphasize importance of medication compliance and keeping all follow-up appointments
• Discuss activity restrictions and importance of avoiding contact with sick individuals
• Provide information about support groups and resources for families

Self-Assessment

• ☐ Can I identify the most common type of childhood leukemia?
• ☐ Do I know the key signs and symptoms of leukemia?
• ☐ Can I explain infection prevention measures?
• ☐ Do I understand bleeding precautions?
• ☐ Can I differentiate between ALL and AML?
• ☐ Do I know when to contact the physician immediately?