Leukemia is a malignant proliferation of white blood cell precursors in bone marrow or lymph tissue and their accumulation in peripheral blood, bone marrow, and body tissues. The blood’s cellular components originate primarily in the marrow of bones such as the sternum, iliac crest, and cranium. All blood cells begin as immature cells (blasts or stem cells) that differentiate and mature into RBCs, platelets, and various types of WBCs. In leukemia, many immature or ineffective WBCs crowd out the developing normal cells. As the normal cells are replaced by leukemic cells, anemia, neutropenia, and thrombocytopenia occur.
Nursing Care Plans
The care plan for patients with leukemia should be emphasized on comfort, minimize the adverse effects of chemotherapy, promote preservation of veins, manage complications, and provide teaching and psychological support.
Here are five (5) nursing care plans (NCP) for leukemia:
- Risk for Infection
- Risk for Deficient Fluid Volume
- Acute Pain
- Activity Intolerance
- Deficient Knowledge
- Other Possible Nursing Care Plans
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
Risk factors may include
- Inadequate secondary defenses: alterations in mature WBCs (low granulocyte and abnormal lymphocyte count), increased number of immature lymphocytes; immunosuppression, bone marrow suppression (effects of therapy/transplant)
- Inadequate primary defenses (stasis of body fluids, traumatized tissue)
- Invasive procedures
- Malnutrition; chronic disease
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- Identify actions to prevent/reduce risk of infection.
- Demonstrate techniques, lifestyle changes to promote safe environment, achieve timely healing.
|Place in a private room. Limit visitors as indicated. Prohibit live plants or flowers. Restrict fresh fruits and make sure they are properly washed or peeled. Coordinate patient care so that leukemic patient doesn’t come in contact with staff who also care for patients with infections or infectious diseases.||To protect the patient from potential sources of pathogens or infection. Bone marrow suppression, neutropenia, and chemotherapy places the patient at high risk for infection.|
|Require good hand washing protocol for all personnel and visitors.||Prevents cross-contamination and reduces risk of infection.|
|Closely monitor temperature. Note correlation between temperature elevations and chemotherapy treatments. Observe for fever associated with tachycardia, hypotension, subtle mental changes.||Although fever may accompany some forms of chemotherapy, progressive hyperthermia occurs in some types of infections, and fever (unrelated to drugs or blood products) occurs in most leukemia patients. Septicemia may occur without fever.|
|Prevent chilling. Force fluids, administer tepid sponge bath.||Helps reduce fever, which contributes to fluid imbalance, discomfort, and CNS complications.|
|Encourage frequent turning and deep breathing.||Prevents stasis of respiratory secretions, reducing risk of atelectasis or pneumonia.|
|Auscultate breath sounds, noting crackles, rhonchi. Inspect secretions for changes in characteristics: increased sputum production or change in sputum color. Observe urine for signs of infection: cloudy, foul-smelling, or presence of urgency or burning with voids.||Early intervention is essential to prevent sepsis in immuno-suppressed person.|
|Handle patient gently. Keep linens dry and wrinkle-free.||Prevents sheet burn and skin excoriation.|
|Inspect skin for tender, erythematous areas; open wounds. Cleanse skin with antibacterial solutions.||May indicate local infection. Open wounds may not produce pus because of insufficient number of granulocytes.|
|Inspect oral mucous membranes. Provide good oral hygiene. Use a soft toothbrush, sponge, or swabs for frequent mouth care.||The oral cavity is an excellent medium for growth of organisms and is susceptible to ulceration and bleeding.|
|Avoid using indwelling urinary catheters and giving I.M. injections.||These can provide an avenue for infection.|
|Provide thorough skin care by keeping the patient’s skin and perianal area clean, apply mild lotion or creams to keep the skin from drying or cracking. Thoroughly clean skin before all invasive skin procedures.||Additional measures to avoid infection.|
|Change IV tubing according to your facility’s policy. Use strict sterile technique and a metal scalp vein needles (metal butterfly needle) when starting IV. If the patient receives total parenteral nutrition, give scrupulous subclavian catheter care.||IV sites can harbor infection. Additional measure to avoid infection.|
|Promote good perianal hygiene. Examine perianal area at least daily during acute illness. Provide sitz baths, using Betadine or Hibiclens if indicated. Avoid rectal temperatures, use of suppositories.||Promotes cleanliness, reducing risk of perianal abscess; enhances circulation and healing. Perianal abscess can contribute to septicemia and death in immune compromised patients.|
|Coordinate procedures and tests to allow for uninterrupted rest periods.||Conserves energy for healing, cellular regeneration.|
|Encourage increased intake of foods high in protein and fluids with adequate fiber.||Promotes healing and prevents dehydration. Constipation potentiates retention of toxins and risk of rectal irritation or tissue injury.|
|Limit invasive procedures (venipuncture and injections) as possible.||Break in skin could provide an entry for pathogenic or potentially lethal organisms. Use of central venous lines (tunneled catheter or implanted port) can effectively reduce need for frequent invasive procedures and risk of infection. Myelo suppression may be cumulative in nature, especially when multiple drug therapy (including steroids) is prescribed.|
|Monitor laboratory studies:|
|Decreased numbers of normal or mature WBCs can result from the disease process or chemotherapy, compromising the immune response and increasing risk of infection.|
|Verifies presence of infections; identifies specific organisms and appropriate therapy.|
|Indicator of development or resolution of respiratory complications.|
|Prepare for and assist with leukemia-specific treatments such as chemotherapy, radiation, and/or bone marrow transplant.||Leukemia is usually treated with a combination of these agents, each requiring specific safety precautions for patient and care providers.|
|Administer medications as indicated:|
|May be given prophylactically or to treat specific infection.|
|Restores WBCs destroyed by chemotherapy and reduces risk of severe infection and death in certain types of leukemia.|
|Avoid use of aspirin-containing antipyretics.||Aspirin can cause gastric bleeding and further decrease platelet count.|
|Provide nutritious diet, high in protein and calories, avoiding raw fruits, vegetables, or uncooked meats.||Proper nutrition enhances immune system. Minimizes potential sources of bacterial contamination.|
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Hematologic and Lymphatic Care Plans
Care plans related to the hematologic and lymphatic system:
- Anaphylactic Shock | 4 Care Plans
- Anemia | 4 Care Plans
- Aortic Aneurysm | 4 Care Plans
- Deep Vein Thrombosis | 5 Care Plans
- Disseminated Intravascular Coagulation | 4 Care Plans
- Hemophilia | 5 Care Plans
- Leukemia | 5 Care Plans
- Lymphoma | 3 Care Plans
- Sepsis and Septicemia | 6 Care Plans
- Sickle Cell Anemia Crisis | 6 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans