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5 Leukemia Nursing Care Plans

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By Matt Vera, BSN, R.N.
Leukemia Nursing Care Plans
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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) and nursing diagnosis for patients with leukemia: 

  1. Risk for Infection
  2. Risk for Deficient Fluid Volume
  3. Acute Pain
  4. Activity Intolerance
  5. Deficient Knowledge
  6. Other Possible Nursing Care Plans

3. Acute Pain

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Acute Pain

Nursing Diagnosis

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May be related to

  • Physical agents, e.g., enlarged organs/lymph nodes, bone marrow packed with leukemic cells
  • Chemical agents, e.g., antileukemic treatments
  • Psychological manifestations, e.g., anxiety, fear

Possibly evidenced by

  • Reports of pain (bone, nerve, headaches, and so forth)
  • Guarding/distraction behaviors, facial grimacing, alteration in muscle tone
  • Autonomic responses

Desired Outcomes

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  • Report pain is relieved/controlled.
  • Appear relaxed and able to sleep/rest appropriately.
  • Demonstrate behaviors to manage pain.
Nursing InterventionsRationale
Investigate reports of pain. Note changes in degree (use scale of 0–10) and site.Helpful in assessing need for intervention; may indicate developing complications.
Monitor vital signs, note nonverbal cues, e.g., muscle tension, restlessness.May be useful in evaluating verbal comments and effectiveness of interventions.
Provide quiet environment and reduce stressful stimuli. Limit or reduce noise, lighting, constant interruptions.Promotes rest and enhances coping abilities.
Place in position of comfort and support joints, extremities with pillows or padding.May decrease associated bone or joint discomfort.
Reposition periodically and assist with gentle ROM exercises.Improves tissue circulation and joint mobility.
Provide comfort measures (massage, cool packs) and psychological support, encouragement, or presence.Minimizes need for or enhances effects of medication.
Review patient’s own comfort measures.Successful management of pain requires patient involvement. Use of effective techniques provides positive reinforcement, promotes sense of control, and prepares patient for interventions to be used after discharge.
Evaluate and support patient’s coping mechanisms.Using own learned perceptions or behaviors to manage pain can help patient cope more effectively.
Encourage use of stress management techniques. Teach relaxation and deep-breathing exercises, guided imagery, visualization.Facilitates relaxation, augments pharmacological therapy, and enhances coping abilities.
Assist with and provide diversional activities, relaxation techniques.Helps with pain management by redirecting attention.
Monitor uric acid level as appropriate.Rapid turnover and destruction of leukemic cells during chemotherapy can elevate uric acid, causing swollen painful joints in some patients. Massive infiltration of WBCs into joints can also result in intense pain.
Administer medications as indicated: 
  • Analgesics: acetaminophen (Tylenol)
Given for mild pain not relieved by comfort measures. Avoid aspirin-containing products because they may potentiate hemorrhage.
  • Opioids: codeine, morphine, hydromorphone (Dilaudid)
Used around-the-clock, rather than prn, when pain is severe. Use of patient-controlled analgesia (PCA) is beneficial in preventing peaks and valleys associated with intermittent drug administration and increases patient’s sense of control.
  • Antianxiety agents: diazepam (Valium), lorazepam (Ativan).
May be given to enhance the action of analgesics or opioids.
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3. Acute Pain

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans for hematologic and lymphatic system disorders:

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Matt Vera, BSN, R.N.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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