Recall 4-year-okd Sam, who was described in the opening scenario. He was recently diagnosed with acute lymphocytic leukemia (ALL) and has begun treatment. Both his mother and father are strong supports, and his older siblings, Jeffrey (6 years) and Blake (8 years), are worried about and protective of their younger brother, On a recent clinic visit, Sam’s hemoglobin was found to be 6 g/dl

1.       Sam has had several procedures already that are painful and have required sedation. Plan to prepare him for a lumbar puncture for which he will be sedated. Consider his age as yon plan how far ahead to tell him, how to explain the room he will be in, and how you will include his parents in the procedure

.  2.Lack of all blood cellular components is a side effect of leukemia treatment. Explain why Sam’s hemoglobin is low See Pearson Nursing Student Resources for possible responses What is the expected level? What colony-stimulating factor might be used in his treatment to increase RBCs? What dietary teaching can you do to enhance hemoglobin levels?

3.Infection is a frequent complication of treatment for leukemia. During Sam’s clinic visits, what assessments will you make to monitor for infection?

4.Jeffrey and Blake are attending one of Sam’s clinic visits when he receives chemotherapy. What questions and activities will you plan for them during the visit? What can you do to increase their knowledge and help them feel like they are part of Sam’s care? Could their concern for Sam influence their own school performance What should their teachers know about the fact that they have a sibling who has leukemia?