5 Leukemia Nursing Care Plans

Risk for Infection

Clients with leukemia are at risk for infection due to the disease’s impact on the bone marrow and immune system. Leukemia disrupts the production of normal blood cells, including white blood cells that play a crucial role in fighting infections, leaving the body vulnerable to bacterial, fungal, and viral infections. Additionally, chemotherapy and other treatments for leukemia can further suppress the immune system, increasing the risk of infection.

Nursing Diagnosis

• Risk for Infection

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.

Desired Outcomes

• The client will identify actions to prevent/reduce risk of infection.
• The client will demonstrate techniques, and lifestyle changes to promote a safe environment, and achieve timely healing.

Nursing Assessment and Rationales

1. Closely monitor the temperature. Note the correlation between temperature elevations and chemotherapy treatments. Observe for fever associated with tachycardia, hypotension, and 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.

2. Inspect the skin for tender, erythematous areas; open wounds. Cleanse skin with antibacterial solutions.
This may indicate local infection. Open wounds may not produce pus because of the insufficient number of granulocytes.

3. 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 the growth of organisms and is susceptible to ulceration and bleeding.

4. Auscultate breath sounds, noting crackles, and 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 persons.

5. Monitor laboratory studies:

• 5.1. CBC, noting whether WBC count falls or sudden changes occur in neutrophils.
  Decreased numbers of normal or mature WBCs can result from the disease process or chemotherapy, compromising the immune response and increasing the risk of infection.

• 5.2. Gram stain cultures and sensitivity.
  Verifies presence of infections; identifies specific organisms and appropriate therapy.

• 5.3. Review serial chest x-rays.
  Indicator of development or resolution of respiratory complications.

Nursing Interventions and Rationales

1. 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 place the patient at high risk for infection.

2. Require good hand washing protocol for all personnel and visitors.
Prevents cross-contamination and reduces the risk of infection.

3. Prevent chilling. Force fluids, and administer a tepid sponge bath.
Helps reduce fever, which contributes to fluid imbalance, discomfort, and CNS complications.

4. Encourage frequent turning and deep breathing.
Prevents stasis of respiratory secretions, reducing the risk of atelectasis or pneumonia.

5. Handle the patient gently. Keep linens dry and wrinkle-free.
Prevents sheet burn and skin excoriation.

6. Avoid using indwelling urinary catheters and giving I.M. injections.
These can provide an avenue for infection.

7. Provide thorough skin care by keeping the patient’s skin and perianal area clean, and 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.

8. Change IV tubing according to your facility’s policy. Use a strict sterile technique and metal scalp vein needles (metal butterfly needles) when starting an IV. If the patient receives total parenteral nutrition, give scrupulous subclavian catheter care.
It is essential to change both the IV site and tubing for patients with leukemia to minimize the risk of infection and ensure proper medication delivery. The frequent administration of chemotherapy and other treatments through the IV can lead to irritation and inflammation of the vein, increasing the risk of infection. Changing the IV site can help prevent further damage to the vein and minimize the risk of infection. Similarly, changing the IV tubing can help maintain sterility, reduce the risk of contamination, and ensure the proper delivery of medications.

9. Promote good perianal hygiene. Examine the perianal area at least daily during acute illness. Provide sitz baths, using Betadine or Hibiclens if indicated. Avoid rectal temperatures, and use of suppositories.
Promotes cleanliness, reducing the risk of perianal abscess; enhances circulation and healing. A perianal abscess can contribute to septicemia and death in immune-compromised patients.

10. Coordinate procedures and tests to allow for uninterrupted rest periods.
Conserves energy for healing, and cellular regeneration.

11. Encourage increased intake of foods high in protein and fluids with adequate fiber.
Promotes healing and prevents dehydration. Constipation potentiates the retention of toxins and the risk of rectal irritation or tissue injury.

12. Limit invasive procedures (venipuncture and injections) as possible.
A break in the skin could provide an entry for pathogenic or potentially lethal organisms. The use of central venous lines (tunneled catheter or implanted port) can effectively reduce the need for frequent invasive procedures and the risk of infection. Myelo suppression may be cumulative in nature, especially when multiple drug therapy (including steroids) is prescribed.

13. 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 patients and care providers.

14. Administer medications as indicated: 

• 14.1. Antibiotics
  May be given prophylactically or to treat specific infections.

• 14.2. Colony-stimulating factors: sargramostim (Leukine)
  Restores WBCs destroyed by chemotherapy and reduces the risk of severe infection and death in certain types of leukemia.

15. Avoid the use of aspirin-containing antipyretics.
Aspirin can cause gastric bleeding and further decrease, platelet count.

16. Provide a nutritious diet, high in protein and calories, avoiding raw fruits, vegetables, or uncooked meats.
Proper nutrition enhances the immune system. Minimizes potential sources of bacterial contamination.