During induction chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers, fruit, and plants can carry microbes and should be avoided. Teach proper hand washing using antibacterial soap before and after each care activity. Hand washing and hand hygiene lessen the risk of cross-contamination. Note: Methicillin-resistant Staphylococcus aureus (MRSA) is most commonly transmitted bacteria via direct contact with health care workers who are unable to wash hands between client contacts.

Option A: Books and magazines can be brought to the patient, but they should be disinfected. Encourage the client to cover their mouth and nose with a tissue when coughing or sneezing. Place in a private room if indicated. Wear a mask when providing direct as appropriate. Appropriate behaviors, personal protective equipment, and isolation prevent the spread of infection via airborne droplets.
Option B: Personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination. Body substance isolation should be used for all infectious clients. Wound and linen isolation and hand washing may be all that is required for draining wounds. Clients with diseases transmitted through air may also need airborne and droplet precautions.
Option D: The pictures should be disinfected before given to the client. Note temperature trends and observe for shaking chills and profuse diaphoresis. Fever [101°F-105°F (38.5°C-40°C)] is the result of endotoxin effect on the hypothalamus and pyrogen-released endorphins. Hypothermia lower than 96°F (36°C) is a grave sign reflecting advancing shock state, decreased tissue perfusion, and failure of the body’s ability to mount a febrile response. Chills often precede temperature spikes in the presence of generalized infection.

The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. It is diagnosed in about 4000 people in the United States each year with the majority being under the age of 18. It is the most common malignancy of childhood. The peak age of diagnosis is between two and ten years of age.

Option B: ALL is uncommon during young adulthood. Acute Lymphocytic Leukemia is more common in children with Trisomy 21 (Down syndrome), neurofibromatosis type 1, Bloom syndrome, and ataxia telangiectasia. All are common in children between two and three years of age.
Option C: The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. Prognosis is diminished in children when diagnosed in infants less than one year of age and in adults. It is more favorable for children. Association of the MLL gene in children at 11q23 chromosome is associated with poor prognosis.
Option D: The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years. Lymphocytic Leukemia is a disease with low incidence overall in population studies. The incidence of Acute Lymphocytic Leukemia is about 3.3 cases per 100,000 children. Survival rates for ALL have improved dramatically since the 1980s, with a current five-year overall survival rate estimated at greater than 85 percent.

Symptoms of Hodgkin’s disease include night sweats, fatigue, weakness, and tachycardia. Hodgkin lymphoma (HL), formerly called Hodgkin’s disease, is a rare monoclonal lymphoid neoplasm with high cure rates. Biological and clinical studies have divided this disease entity into two distinct categories: classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma (NLP-HL).

Option A: The disease is characterized by painless, enlarged cervical lymph nodes. Patients with Hodgkin lymphoma frequently present with painless supra-diaphragmatic lymphadenopathy (one to two lymph node areas), B symptoms including unexplained profound weight loss, high fevers, and drenching night sweats.
Option C: Nausea and vomiting are not typically symptoms of Hodgkin’s disease. Chronic pruritus is another disease symptom that may be encountered. If mediastinal nodes enlargement is significant, the mass effect can produce chest pain and shortness of breath. If the patient has an extra-nodal disease, which is less common, related clinical manifestations may occur.
Option D: Weight loss occurs early in the disease. Four features characterize Hodgkin lymphomas. They commonly arise in the cervical lymph nodes; the disease is more common in young adults; there are scattered large mononuclear Hodgkin and multinucleated cells (Reed-Sternberg) intermixed in a background of a mixture of non-neoplastic inflammatory cells; finally, T lymphocytes are often observed surrounding the characteristic neoplastic cells.

A definitive diagnosis of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Four features characterize Hodgkin lymphomas. They commonly arise in the cervical lymph nodes; the disease is more common in young adults; there are scattered large mononuclear Hodgkin and multinucleated cells (Reed-Sternberg) intermixed in a background of a mixture of non-neoplastic inflammatory cells; finally, T lymphocytes are often observed surrounding the characteristic neoplastic cells.

Option B: Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Lymphoblast is an immature white blood cell that gives rise to a type of immune cell known as a lymphocyte. The nucleus contains moderately fine chromatin (readily stainable nuclear material) and has a well-defined nuclear membrane. There are one or two nucleoli, and the cytoplasm is small or moderate in amount. Lymphoblasts that grow and divide uncontrollably cause a type of cancer known as acute lymphoblastic leukemia.
Option C: Gaucher’s cells are large storage cells found in patients with Gaucher’s disease. The Gaucher cell results from the accumulation of excessive glucocerebroside in cells of the monocyte-macrophage system. It is characterized ultrastructurally by the presence of cytoplasmic inclusions which consist of tubule-like structures measuring 130 to 150 Ao in diameter.
Option D: Rieder’s cells are myeloblasts found in patients with acute myelogenous leukemia. They are abnormal myeloblasts in which the nucleus may be widely or deeply indented or may actually be a bilobate or multilobate structure; frequently observed in acute leukemia.

Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Stay with the patient during panic attacks. Use short, simple directions. Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.

Option A: Warning the patient to remain still will likely increase her anxiety. Maintain a calm, non-threatening manner while working with the client. Anxiety is contagious and may be transferred from health care provider to client or vice versa. Client develops feeling of security in presence of calm staff person.
Option B: Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.) Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked.
Option D: Delaying the procedure is unlikely to allay her fears. Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available, and respecting the client’s use of personal space.