Acute Lymphoblastic Leukaemia Assessment Answer

Part 1

Acute Lymphoblastic Leukemia

Pathophysiology

The disease is caused by the uncontrolled proliferation of abnormal and immature proliferation which is consequently leading to the replacement of the bone marrow elements. This disease is more common among males than in females and it is accounting for 2% of lymphoid neoplasms. The disease occurs when the DNA has been damaged leading the lymphocytes to undergo uncontrolled growth spreading throughout the body (Roberts, 2018). This then leads to splenomegaly and apart acromegaly which is caused by sequestration of the platelets and lymphocytes in the spleen and liver respectively. This happens because the white blood cells are not recognized by the spleen causing a reaction. The spleen reacts against white blood cells forcing them out of the blood (Jain & Litzow, 2018). Generally, the disease is caused by chromosomal abnormalities and genetic alterations that are caused by differentiation and proliferation of the precursor linkages. In children, the disease develops from the T cell precursors. The disease is characterized by the uncontrolled production of hemopoietic precursor cells within the bone marrow

Risk Factors

One of the risk factors for this disease is clinical factors like age, white blood cell count and how the patient is responding to chemotherapy. Present studies have also shown that genetic alterations have also helped in refining individual prognoses helping in the management of the disease (Hao, Li, Buck, Buck, & Chen, 2019). The disease is also more common in white individuals than in African Americans and the reason is not so clear. Another risk factor is chemical exposure. ALL can be increased by exposure to various chemotherapy drugs like benzene (Acosta & Pelayo, 2020). Other products that may also increase incidences of the disease include cigarette smoking, glues some cleaning products detergents and also paint strippers. Radiation exposure is also one of the risk factors for this disease. For example, the Japanese atomic bomb survivors suffered greatly from the disease due to the nuclear weapon. Treatment of cancer using radiation therapy is also creating a risk for cases of leukaemia and ALL (Krawczuk, Zak, & Jaworowska, 2019). Exposure to certain levels of radiation such as X-ray and CT scans is also believed to be increasing cases of this disease even though the extent is not well understood. Certain viral infections like human T cell lymphoma have also been associated with the cause of this disease. Genetic syndromes like Down syndrome, Klinefelter’s syndrome, Neurofibromatosis and Bloom syndrome are also associated with this disease.

Diagnosis

ALL is diagnosed when the blood test shows abnormal blood counts and leukaemia cells. The diagnosis is done by examining the bone marrow through bone marrow biopsy or bone marrow aspiration. It is difficult to diagnose the presence of the cells through the microscope and therefore other additional laboratory tests must be conducted (Cobaleda, Jochum, & Busslinger, 2019). Immunophenotyping has also been used to diagnose T and B lymphocytes. A haematologist will take small samples of bone marrow and examine them under a microscope in a process known as bone marrow biopsy. The procedure normally takes around 30 minutes. Further tests that can also be used in diagnosing the disease is cytogenetic testing which is involving the identification of the genetic makeup of the cancerous cells in a sample of blood bone marrow or another type of tissue (Park, et al., 2021). Polymerase chain reaction is also another type of test that has been used in diagnosis.

Treatment

Some of the treatment methods vary according to age and the results depend also on the diagnosis and cytogenetic testing. Treatment aims to cure the disease and it happens in three phases induction, consolidation, maintenance and central nervous system which is involving prophylaxis. The first phase uses intensive chemotherapy medications so that the leukaemia cells are killed to prevent rapid growth. A complete therapy for ALL depends on the reaction to treatment by the patient. Complete remission is usually achieved by approximately 90%. Roughly 5% of the patients die during treatment while another 5% never achieve initial permission. Several drugs are also used to reduce pain. Stem cell transplanting is also done as a method of treatment for two patients who are having abnormal cytogenetics. cytogenetics is very important because it decides whether the patient is going to have a bone marrow transplant for the disease.

Part 2

Pediatric relative care is different from adult pediatric care in that it is in that improving the quality of life of infants and children who have been diagnosed with long-term conditions. The philosophy of pediatric palliative care remains to give the patients holistic care with the help of multi-disciplinary healthcare support from families, health professionals and collaboratively through community health workers (Abrahams & Whitlock, 2019). Due to the diverse nature and special needs of younger people palliative care acknowledges that the differences require ethical considerations focused on providing the physical, emotional, social, cultural and spiritual needs of the children and the family. Concerning children's palliative care in comparison to adult palliative care it is observed that children do not have consent to make decisions and therefore most of the decisions depend on their parents, carers and other health professionals through collaborative communication.

Developmental Aspect about Death (8 years old)

Before the age of 3 years, children's cognitive and language development is not well matured and they do not have any concept on it comes to death. According to previous research that has been done on cognitive development death is considered reversible for children aged 3-5 years. To them, the dead people are simply less alive. According to Jean Piaget’s operational development, this age group does not recognize death as an irreversible process (Alexander & Adlerstein, 1958). However, children in stage 2 whose ages are between 5 to 9 years have already complimented the finality of death but they only believe that it is only happening to other people. In the third stage which is age 10 the causes of death are usually understood and perceived as final. At this stage, death is understood to be inevitable and is associated with the cessation of bodily activities. Due to differences in child development, many variations may occur at different stages and due to emotional development (Archibald, Bell, Miller, & Tuddenham, 1962). Rudy belongs to this stage. He has comprehended death. He is already making plans and other funeral arrangements. He wants a type of coffin that that is reflecting his personality. This is an indication that he has already accepted death as finality.

How to Respond to Death and Dying Questions

Nurses and other professionals have the duty of showing care and empathy while also sympathizing with the family members to help them comfort and prepare the patients for death. One of how nurses can do this by comforting Molly and James and informing them that death is a natural process that must occur in every individual. Counselling sessions should also be provided for the family and the patient to ensure that they are accepting the situation as it is (Arthur & Kemme, 1964). This should ensure that the family and the patient have developed self-control and an accountable approach when it comes to Rudy’s condition. Through collaborative consultation, the professionals and the family members can be able to respond to the issues raised about death and day about Rudy.

Making use of Final Moments

Rudy and his family can maximize the remaining time to help in planning for his funeral considering that he has already accepted that he's going to die ultimately. Rudy can organize a party so that he can bid his family and school friends goodbye. He can also visit other sick patients in the hospital and encourage them. Rudy can also engage in social responsibility programs in the community by engaging in fundraising to help support cancer patients and other patients who are facing terminal diseases. Apart from fundraising Rudy can also engage in community talks offering advice and support to other members of the community who are also facing terminal diseases. Through such collaborative and corporate social responsibilities in society, it is possible that Rudy can ultimately find strength in preparing for his death while also planning for his funeral. Rudy should also be encouraged to play more with his friends.

“There's no Tragedy in Life like the Death of a Child”

The death of a child can indeed be very traumatic and things never get back to the normal way they used to be especially for the parents. The situation is even much was for Cara's other health professionals like the nurses because they spend too much time with the patients. It is also expected that children being young are supposed to outlive their parents and therefore die before their parents become very stressed and emotional. To support the family nurses and other professionals and encourage the family and the patients to speak openly and honestly about their emotional and physical feelings (Balk, 1983). This will help them to air out some of the emotional issues that they may be hiding. It is also important to encourage them to speak and provide them with listening skills and a nonjudgmental environment first this will help them feel appreciated and accepted in society (Barry, 1949). Nothing and healthcare professionals should learn proper mental health I'll also remind them to properly rest hydrate and have enough food. This will help them adjust to the grieving process.

Spiritual motivation is also very important as it gives the family members time to reflect on God. It is also necessary to provide referrals such as psychological referrals and even offer Molly and James to community peer support groups to talk to them. Group therapy and individual therapy can also be utilized to help in supporting the family members who go through their grief.

References

Abrahams, M., & Whitlock, F. (2019). Childhood experiences and depression. British Journal of Psychiatry , 115: 883-888, .

Acosta, D., & Pelayo, R. (2020). Lineage switching in acute leukemias: a consequence of stem cell plasticity? Bone Marrow Res , 406796.

Alexander, I., & Adlerstein, A. .. (1958). Affective responses to the concept of death in a population of children and early adolescents. Journal of Genetic Psychology , 93: 167-177.

Archibald, H., Bell, D., Miller, C., & Tuddenham, R. (1962). Bereavement in childhood and adult psychiatric disturbance. Psychosomatic Medicine , 4: 343-351,.

Arthur, B., & Kemme, M. (1964). Bereavement in childhood. Journal of Child Psychology and Psychiatry , 5: 37-49.

Balk, D. (1983). Effects of sibling death on teenagers. Journal of School Health , 53: 14-18.

Barry, H. (1949). Significance of maternal bereavement before the age of eight in psychiatric patients. Archives of Neurology and Psychiatry , 62: 630-637.

Cobaleda, C., Jochum, W., & Busslinger, M. (2019). Conversion of mature B-cells into T-cells by dedifferentiation to uncommitted progenitors. Nature , 449:473–477.

Hao, T., Li, T., Buck, M., Buck, A., & Chen, W. (2019). An emerging trend of rapid increase of leukemia but not all cancers in the aging population in the United States. Sci Rep , 9:12070.

Jain, T., & Litzow, M. (2018). No free rides: management of toxicities of novel immunotherapies in ALL, including financial. Hematology Am Soc Hematol Educ Program , 30;(1):25-34.

Krawczuk, R., Zak, J., & Jaworowska, B. (2019). A lineage switch from AML to ALL with persistent translocation t(4;11) in congenital leukemia. Med Pediatr Oncol , 41:95–96.

Park, M., Koh, K., Kim, B., Im, H., Jang, S., & P. C. (2021). Lineage switch at relapse of childhood acute leukemia: a report of four cases. J Korean Med Sci , 26:829–831.

Roberts, K. (2018). Genetics and prognosis of ALL in children vs adults. Hematology Am Soc Hematol Educ Program , 30;2018(1):137-145.

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