Childhood Acute Lymphoblastic Leukemia Treatment

Assignment Task

Case Study

Rudy is eight (8) years old. He is one of three (3) children of Molly and James. Rudy was diagnosed with Acute Lymphoblastic Leukaemia (ALL) two (2) year ago and has now relapsed. Since his diagnosis, Rudy has been treated with chemotherapy, radiotherapy, a bone marrow transplant (BMT), and immunotherapy. Despite rates of up to 70% survival following a BMT recorded, Rudy has relapsed, and this refers to the return of acute lymphoblastic leukemia (ALL) in patients who have already undergone treatment for the disease. It is noted that between 15 and 20 percent of children who are treated for ALL and achieve an initial complete remission, will have the disease return. Rudy was recently discharged from hospital following another cycle of chemotherapy. You are a community health nurse and are visiting Rudy and his family today. Prior to arrival, you read Rudy’s hospital discharge notes and find that his condition had not responded well to chemotherapy. For this reason, Molly and James decided to take Rudy home and care for him there.

Rudy was discharged with neutropenia, anaemia, oral mucositis, and pain (currently controlled by opiate analgesia). Rudy weighs 24 kg. He is on oral (immediate release) morphine 50 mcgs 4/24 (normal dose is 10mcg/kg/dose); Paracetamol 360mg 6/24 (15mg/kg dose); an anti-emetic prn, and oral antibiotics QID. 

On arrival, you observe Rudy sitting on a comfortable chair in the family room; he is observing his two siblings playing nearby. He appears pale. Rudy’s mother, Molly, is preparing lunch for the family. 

You introduce yourself to Rudy and his family and obtain permission to assess Rudy. You then conduct a pain assessment and record the following findings:

Pain score = 3 on Wong-Baker FACES Pain Rating Scale. Rudy tells you that his mouth is sore, and his tummy hurts a “little bit”. You proceed with the clinical assessment and find the following:

Temperature = 37.7C; HR = 120 bpm; RR = 22; BP = 95/60; SpO2 = 95% on RA Molly tells you that Rudy is not interested in playing with his siblings since he was last discharged from hospital. Molly is wondering how she will answer Rudy’s and his sibling’s questions about death and dying. Rudy has expressed a wish to help organise his funeral and would like a casket that reflects his likes, personality and lifestyle.

Based on the information provided in the case study about a child with leukaemia who has relapsed. No further treatment options are available and the child is now receiving palliative care

Part

1: Outline and explain acute lymphoblastic leukaemia (ALL) (This is generic and does not include Rudy)

• Pathophysiology (this requires patho related to the bone marrow and the development of blood cells).
• Risk factors
• Diagnosis
• Treatment

2: This is specific to Rudy

• Explore the concept of palliative care for children and how is it differs from adult palliative care.
• Outline the developmental aspects in relation to the concept of death for an 8-year-old.
• Explore how nurses and other professionals can assist Molly and James to answer Rudy’s and his sibling’s questions about death and dying.
• Consider ways in which Rudy and his family can make the most of the time that he has left, including planning his funeral and having the opportunity to say goodbye to siblings, family and school friends.
• The death of a child is a traumatic event that can have long-term effects on the lives of parents. Consider the statement by Dwight D. Eisenhower the 34th president of the United States of America from 1953 to 1961 that “There's no tragedy in life like the death of a child. Things never get back to the way they were.” Explain what this quote means with reference to the social norm that “children are meant to outlive their parents,” and outline strategies that nurses (and other professionals) can use to assist the family in their grief.

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