الفهرس 
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Abstract
Leukemia is the cancer in the bone marrow and blood .There are several strategies to treat leukemia; chemotherapy is considered the standard therapy for children with acute leukemia in the aim of controlling the disease. Inspite of the efficiency of chemotherapy, it could damage the normal as well as leukemic cells that lead to a variety of side-effects. Nausea and vomiting are the most distressing side-effects of chemotherapy. Non-pharmacological interventions such as relaxation technique, self-hypnosis, biofeedback, thought aversion technique, guided imagery, music therapy, herbal therapy (e.g. ginger) and acupressure are effective in reducing the frequency of nausea and vomiting. So, Pediatric nurses play an important role in the assessment and management of chemotherapy gastrointestinal side-effects for children with leukemia.
The aim of this study was to assess the effect of acupressure versus ginger on gastrointestinal side-effects of chemotherapy for children with leukemia. The study was conducted at the Inpatient and Outpatient Hematology/Oncology Unit at Alexandria University Children’s Hospital at Smouha. A convenience sampling of 90 children with acute lymphoblastic leukemia comprised the study subjects, their ages ranged from 7-15 years, were receiving intensive chemotherapy. The study subjects were divided into three equal groups as; control, acupressure and ginger groups. Three tools were used to collect the necessary data. Tool one: assessment of biosocial data of children, tool two: assessment of nausea, vomiting, diarrhea and dehydration that was developed by the researcher that guided by Verna, 1996. Tool three: assessment of severity of nausea and vomiting by visual analogue scale that was developed by Fairbank, Davies(1980) and modified by Baxter (2011).
Assessment of Children’s demographic data and chemotherapy gastrointestinal side-effects was done by the researcher before and during the chemotherapy. The control group received only the routine care of the hospital. While, the acupressure group received acupressure technique by applying finger massage in a circular clockwise direction at PC6 acupoint. The acupressure massage was conducted for duration of 20 minutes before meals. A ginger powdered capsule was provided 30 minutes before meals for ginger group. Both of them were done for three times daily in three consequent sessions of chemotherapy. The follow up for the children’s gastrointestinal side-effects was carried out on the fourth day of the 3rd session of chemotherapy for the three groups.
The main results of the present study are the following:
Biosocial and Clinical Data for Children with Leukemia
More than half of children in the three studied groups (control, acupressure and ginger) were aged from 7 to 9 years (63.3%, 56.7%and 56.7 respectively) and the majority of them were males (80%, 83.3%, and 73.3% respectively).
Percentages of Studied Children Regarding the Occurrence of Chemotherapy Gastrointestinal Side-effects
In 1st session of experienced nausea, the percentages of children were decreasing through the three days of ginger group (60.0%, 23.3% and 13.3% respectively) compared to the percentages of children in acupressure group (93.3%, 80.0%, and 13.3% respectively). While, all children in the control group (100%) were experiencing nausea and statistical significant difference was found.
In 2nd sessions of experienced nausea, the percentages of children were decreasing through the three days of ginger group (70.0%, 36.7% and 3.3% respectively)
compared to the percentages of children in acupressure group (93.3%, 60.0%, and 10.0% respectively). While, all children in control group (100%) were experiencing nausea and statistical significant difference was found.
In 3rd session of experienced nausea, the percentages of children were decreasing through the first two days of ginger group (66.7% and 26.7% respectively) compared to the percentages of children in acupressure group (73.3% and 80.0% respectively). While, all children in the control group were experiencing nausea (100%) and significant difference was illustrated.
In 1st session of experienced vomiting, 30% of children had vomiting on the first day of ginger group compared to 73.3% of children in acupressure group and 100% of children in the control group and significant difference was found.
In 2nd session of experienced vomiting, the percentages of children were decreasing through the three days of ginger group (33.3%, 13.3% and 3.3% respectively) compared to the percentages of children in acupressure group (60.0%, 10.0%, and 6.7% respectively). While, all children in control group (100%) were experiencing vomiting and statistical significant difference was illustrated.
In 3rd session of experienced vomiting, the percentages of children were decreasing through the first and second day of ginger group (36.7% and 0.0% respectively) compared to the percentages of children in acupressure group (46.7% and 20.0% respectively),while all children in the control group were experiencing vomiting (100%) and the difference was statistically significant.
In 2nd and 3rd sessions of experienced diarrhea, small percentages of children had diarrhea on the first day of control group (10%, 13.3%respectively) compared to none of children in ginger and acupressure groups and significant difference was found.
In 1st session of experienced dehydration, small percentages of children had dehydration in the first day in control, acupressure and ginger groups (16.7, 10.0% and 3.3% respectively).
The Experienced Chemotherapy Gastrointestinal Side-Effects for Children in the Three Studied Groups (Control, Acupressure& Ginger)
A-The Experienced Chemotherapy Gastrointestinal Side-Effects for Children in Control Group
The majority of children were having nausea for duration of five minutes (83.3%) with decreasing in its frequency (10%, 16.7% and 16.7% respectively).Plus the percentages of children who had anorexia were decreasing (40%, 53.3% and 45.2% respectively). Three quarters or more of children were not having an aggravating factor of nausea (76.7%, 76.7% and 75% respectively).
High percent of children experienced small amount of vomiting (92.9%, 64.3% and 55.6% respectively). The percentages of children who suffered from vomiting associated with feeding in 1st and 2nd sessions were equal (42.9%), while the percent of children in 3rd session increased (66.7%).The frequency of vomiting was once per day for all children (100%).
The frequency of diarrhea was either twice per day for all children who experienced diarrhea on the first day of 1st session or it was three and more times per day for children on the first day of 2nd and 3rd sessions (100%). All children were having diarrhea in form of moderate, watery and acute on the first day of each session (100%).Small percent of children had some degree of dehydration on the first day of 1st and 3rd session (16.7% and 6.7% respectively).
B-The Experienced Chemotherapy Gastrointestinal Side-Effects for Children in Acupressure Group.
The frequency of nausea for children who experienced nausea was once per day (100%).Three quarters of children did not experience any associated symptoms (75.0%) on the third day of 1st session and the percent of children in 2nd and 3rd sessions increased to 100%. All children were not having aggravating factors in 1st and 2nd sessions (100%),while equal percent of children had an aggravating factors related to smelling or seeing foods (50% for each) in 3rd session. Half of children were using sleeping as an eliminating measure (50%) in 1st session.
All children had moderate amount of vomiting, watery in consistency and it was once per day only in frequency for children in 1st and 2nd sessions (100%). All children were not experiencing vomiting associated with meals in 1st session (100%) while, all children were experiencing it in 2nd session (100%).
All children were experiencing diarrhea three times and more per day in the form of moderate, watery and acute on the first day of 1st session. Ten percent only of children had some degree of dehydration on the first day of the 1st session (100%).
C-The Experienced Chemotherapy Gastrointestinal Side-Effects for Children in Ginger Group.
The duration of nausea was five minutes and the frequency was once per day for all children on 3rd session (100%) in 3rd session. Half of the children had anorexia as an associating symptom (50%) in 1st session and 33.3% of children in 3rd session, while the percent of children in 2nd session was decreased to a zero.
All children had moderate amount of vomiting and it was once per day in frequency in 2nd and 3rd sessions (100%) and it was watery in consistency for all children in 2ndand 3rd sessions (100%). All children experienced vomiting associated with feeding in 2nd session (100%).
All children experienced diarrhea three times and more per day in the form of moderate, watery and acute diarrhea on the first day of 1st session
Small percent only of children had some degree of dehydration on the first day of the 1st session (3.3%).
The Relationship between Children’s Chemotherapy Gastrointestinal Side -Effects in Acupressure and Ginger Groups.
None of the children had vomiting on the third day of 1st session of ginger group compared to 3.3% of children in acupressure group and the significant difference was found.
In 2nd session of experienced nausea, more than two thirds of children were using medication as an eliminating measure on the third day of 2nd session of acupressure group (66.7%) compared to 100% of children of ginger group and the difference was statistically significant.
In 2nd session of experienced vomiting, 55.6% of children were experiencing vomiting associated with feeding in the first day in acupressure group compared to none of children in ginger group (0.0%) and significant difference was found.
In 3rd session of experienced nausea, there was statistical significant difference between acupressure and ginger groups, where all children were experiencing nausea for five minutes on the third day in ginger group (100%) compared to 50% of children in acupressure group and all children had not any associating symptoms on the third
day in acupressure group (100%) compared to 33.3% of children in ginger group and significant differences was found.
Follow up for children’s Chemotherapy Gastrointestinal Side-Effects in the Three Studied Groups.
All children experienced nausea once per day in acupressure and ginger groups (100%) compared to 37.5% of children in control group and significant difference was found.
All children were not experiencing vomiting in acupressure group (100%) compared to 93.3% of children in ginger and 70.0% in control groups and significant differences were found.
Follow up for Children’s Chemotherapy Gastrointestinal Side-Effects in Acupressure and Ginger Groups.
All children were not having an aggravating factors in ginger group (0.0%) compared to equal percent of children who had an aggravating factors related to smelling (50%) or seeing foods(50%) and significant differences were found.
The significant difference was not shown in all items of children’s vomiting between the two studied groups. The significant difference was not shown in all items of children’s diarrhea and dehydration between the two studied groups.
The Percentages of Children Regarding to the Severity of Nausea and Vomiting in the Three Studied Groups:
A- In Control Group.
On the third day of the three studied sessions for children’s severity of nausea and vomiting; more than half of the children were experiencing moderate degree of nausea in 1st and 2nd sessions (56.7% and 60% respectively) and moderate degree of nausea was shown for 50% of children in 3rd session.
The mild degree of vomiting was found by all children in 1st and 3rd sessions (100%) and 85.7% of children in 2nd session.
B- In Acupressure Group.
On the third day of the three studied sessions for children’s severity of nausea and vomiting; one quarter of children experienced severe degree of nausea in 1st session (25%) and the percentages of children who experienced nausea in 2nd session were increased to 66.7%, while none of children experienced severe nausea in 3rd session (0.0%).
All children had mild degree of vomiting on the third day of 1st and 2nd sessions (100%), while none of children experienced vomiting on the third day of 3rd session(P=0.02).
C- In Ginger Group.
On the third day of the three studied sessions for children’s severity of nausea and vomiting; none of the children experienced severe degree of nausea in the three studied sessions(0.0%for each) and all children experienced mild degree of vomiting in the 2nd and 3rd sessions (100% for each).
The Relationship between children’s Severity of Nausea and Vomiting in acupressure and ginger groups.
On 1st and 3rd sessions of children’s severity of nausea and vomiting, there were no significant difference was found.
The significant difference was found only in children’s vomiting, where all children experienced mild degree of vomiting on the first day of 2nd session in acupressure group (100%) compared to 90% of children in ginger group.