In this article, we will discuss leukemia nursing care plans and nursing diagnosis that nurses can use to provide effective care for their patients. We will provide a detailed explanation of each plan and diagnosis, as well as tips for implementing effective nursing interventions.
What is Leukemia?
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 providing comfort, minimizing the adverse effects of chemotherapy, promoting the preservation of veins, managing complications, and providing teaching and psychological support.
Here are five (5) nursing care plans (NCP) and nursing diagnoses for patients with leukemia:
- Risk for Infection
- Risk for Deficient Fluid Volume
- Acute Pain
- Activity Intolerance
- Deficient Knowledge
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.
- 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.
- 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.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans for hematologic and lymphatic system disorders:
- Anaphylactic Shock | 4 Care Plans
- Anemia | 6 Care Plans UPDATED!
- 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