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Outline
Pathophysiology
Leukemia is cancer of the blood forming tissues and usually involves the white blood cells. The bone marrow produces abnormal white blood cells that do not function properly. The life cycle of the white blood cells is changed and the cells do not die when they should, thus accumulating and taking up space. They eventually crowd out the good cells which impairs the growth and function of healthy cells. There are many types of leukemia. Some types can be cured while others cannot. Treatment is highly dependent upon the type of leukemia
Etiology
Scientists don’t fully know the exact etiology of leukemia , but believe that it may come from a combination of genetic and environmental factors. Genetics, radiation or chemical exposure, viruses (HIV), previous chemotherapy, and those with Down Syndrome appear to have a higher incidence of leukemia.
Desired Outcome
Minimize complications and resolve if possible. Maximize the normal blood cells and minimize the abnormal cells.
Leukemia Nursing Care Plan
Subjective Data:
- Loss of appetite, weight loss
- Tendency to bruise or bleed
- Fatigue, weakness
- Bone pain
Objective Data:
- Frequent infections
- Fever
- Swollen lymph nodes
- Enlarged liver / spleen
- Petechiae
- Recurrent nosebleeds
- Prolonged clotting factors
- Elevated WBC
- Pallor
Nursing Interventions and Rationales
- Initiate bleeding precautions
Clotting factors are impaired and patients are at a higher risk of bleeding and bruising
- Assess and manage pain appropriately
- Massage
- Positioning
- Cool/heat therapy
- Aromatherapy
- Guided imagery
- Medications as necessary
Pain can be difficult to control and manage and medications may be scheduled with PRN measures for breakthrough pain. Make sure the intervention is appropriate for the patient and avoid extra stressors such as movement. Encourage patient to try non-pharmacological interventions and balance those with medication for more comprehensive pain control.
- Monitor for signs / symptoms of infection or sepsis
Especially during treatment, patients are at higher risk of developing sepsis. Monitor closing for signs and symptoms and notify MD as necessary.
- Promote normothermia
Progressive hyperthermia may occur as the body’s response to disease and effects of treatment. Monitor temperature closely, especially during chemotherapy.
- Anticipate needs
Time pain and nausea medications at their peak according to therapy, chemo and meal times to increase their effectiveness
- Monitor Intake & Output and signs/symptoms of dehydration
- Skin turgor
- Dry mucous membranes
- Capillary refill
Dehydration and kidney compromise is a potential complication of disease and treatment. Encourage hydration and monitor closely.
- Patient and family education
- Symptoms and disease process
- Infection prevention
- Plan of care
Patients and family members must be knowledgeable of process and what to expect to help reduce anxiety and be prepared for complications as they arise. Educate family members and caregivers of the importance to help reduce risk of infection for the patient by practicing good hand hygiene.
- Avoid risk of infection from procedures:
- Foley catheter insertion
- Injections
- Lines and tubes
Lack of sufficient white blood cells damages the immune system and patients are more prone to infections. Weight risk versus benefit.
- Promote self care, independence and ADLs
Fatigue is a common symptom and can prevent the patient from participating in self care. Provide assistance with ADLs as needed and cluster care to reduce fatigue and promote rest. Prioritize activities to help conserve energy for self care.
References
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