Nursing care plan about Leukemia ……………..

Nursing care plan about leukemia

1. Leukemia:pathophysiology,
signs, and management

2. Leukemia is a cancer of the bone
marrow and blood, arising from
mutations in hematopoietic stem cells
that cause the uncontrolled proliferation
of immature or abnormal white blood
cells (WBCs). These abnormal cells
accumulate in the bone marrow,
disrupting the production of normal
blood cells, including red blood cells
(RBCs), platelets, and functional WBCs.
Introduction

3. Signs and symptoms
Fever or chills
Persistent fatigue,
weakness
Swollen lymph
nodes, enlarged
liver or spleen
Easy bleeding or
bruising
Frequent or severe
infections
Losing weight without
trying
Bone/joint pain or
tenderness

4. The patient presents to the ER with complaints of
dizziness that started 2 hours ago. She describes the
dizziness as a spinning sensation (vertigo) and feels
lightheaded when standing up. The patient had
peripheral edema, with lab tests showing a low
hemoglobin level (9.1), red blood cells count of (2.95),
and white blood cells count (1.3) platelet count (3), as
well as potassium and magnesium deficiencies (K:
2.63, m: 1.30). The patient verbalized the pain level is
6/10
Case scenario

5. patient’s name: N
Sex: Female
Age: 35y
Religion: muslim
Marital status: married
Level of education: high school

Demographic data

6. Chief complaint: Dizziness, pale, acute
myelogenous leukemia
Present complaint: The patient was
admitted to ER because of dizziness and
paleness
History of present complaint: The patient
is a 35-year-old female with a known
history of acute myelogenous leukemia,
who presents with a three day of
worsening dizziness
Medical history

7. Present diagnosis: Acute myelogenous
leukemia
Past medical diagnosis: Acute
myelogenous leukemia
Past surgical history: NA
Allergies: NKDA
Medical history

8. Name Dose
Route
Action
Side
effects
POTASSIUM
CHLORIDE
1.
MAGNESIUM2.
FUROSEMIDE3.
CHLORHEXIDINE4.
PARACETAMOL5.
PANTOPRAZOLE6.
PIPERACILLIN
SODIUM
7.
TAZOBACIAM8.
1. 40MEG
2. 2000 MG
3. 20 MG
4. 1 APPLICATION
5. 1000 MG
6. 40 MG
7. 4000 MG
8. 500 MG
Potassium
replacement
1.
Magnesium
replacement
2.
A loop diuretic3.
An antiseptic4.
Pain reliever5.
A proton pump
inhibitor
6.
penicillin antibiotic7.
beta-lactamase
inhibitor
8.
Nausea, vomiting,
abdominal
discomfort
1.
Diarrhea, stomach
cramps, nausea
2.
Dehydration,
electrolyte
imbalance, dizziness
3.
Skin irradiation,
bitter taste, staining
of teeth
4.
Nausea5.
Headache, diarrhea,
stomach pain
6.
Diarrhea, Nausea,
vomiting
7.
Diarrhea, Nausea,
vomiting
8.
Oral1.
Oral2.
Oral3.
Topical4.
Oral5.
Oral6.
IIV7.
IV8.

9. Name Dose
Route
Action
Side
effects
ALLOPURINOL1.
ACYCLOVIR2.
FLUCONAZOLE3.
AESCIN 4.
DIETHYLAMINE
SALICYLATE
5.
NORMAL SALINE6.
ONDANSETRON7.
mitoXANTRONE8.
1. 100MG
2. 400MG
3. 150MG
4. 0.5
application
5. 50ml
6. 8MG
7. 10MG
Reduces uric acid
production
1.
An antiviral2.
An antifungal3.
An anti-
inflammatory agent
4.
A topical analgesic5.
Saltwater solution to
hydrate, dilute
medications, or flush
IV lines/wounds
6.
An antiemetic7.
A chemotherapy drug8.
Rash, diarrhea,
nausea
1.
Nausea, diarrhea,
headache
2.
Nausea, headache,
abdominal pain
3.
Skin irritation4.
Allergic reactions5.
Headache,
constipation, Fatigue
6.
Nausea, vomiting,
hair loss, bone
marrow suppression
7.
Oral1.
Oral2.
Oral3.
Topical4.
IV5.
Oral6.
IV7.

10. Name Dose
Route
Action
Side
effects
CHLORPHENIRAMINE1.
DEXAMETHASONE2.
ETOPOSIDE3.
CYTARABINE4.
10 MG1.
20 MG2.
128 MG3.
1600 MG4.
An antihistamine1.
A corticosteroid that
reduces
inflammation
2.
A chemotherapy drug3.
A chemotherapy drug4.
Drowsiness, dry
mouth, dizziness
1.
Weight gain,
hyperglycemia
2.
Insomnia3.
Nausea, vomiting,
hair loss, bone
marrow suppression
4.
Oral1.
Oral2.
IV3.
IV4.

11. Diagnostic
tests/lab
teses
Results Normal values Interpretation
CBC:
WHITE BLOOD CELL1.
NE %2.
LY %3.
MO%4.
NE#5.
LY #6.
RED BLOOD CELL COUNT7.
HAEMOGLOBIN8.
HAEMATOCRIT9.
MCHC10.
RDW11.
PLATELET COUNT12.
1.311.
19.82.
19.1 3.
61.14.
0.265.
0.25 6.
2.957.
9.18.
25.09.
36.410.
15.011.
312.
4.5-11 (10^3/uL)1.
35-80 (%)2.
24-44 (%) 3.
47-125(%)4.
1.8-7.7 (10^3/uL)5.
1.20-3.60 (10^3/UL)6.
3.8-5.1 (10^6/uL.)7.
11.7-15.5 ( g/di)8.
35-45 (%)9.
32-36 ( g/dI)10.
11.6-14.6 (%)11.
150-440 (10^3/uL)12.
leukopenia1.
neutropenia2.
Slightly low3.
Elevated4.
Neutropenia5.
Low6.
Low, anemia7.
Low8.
Low9.
Slightly elevated10.
Slightly elevated11.
Extremely low12.

12. Nursing Care
Plan

13. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
S:
-“i have dizziness”
verbalized by
patient
O:
hemoglobin
(9.1)
Red blood cells
count (2.95)
Pale
Peripheral
edema
White blood
cells count (1.3)
Platelet count
(3)
GCS 14/15
K- 2.63 m-1.30
Bp 90/58
Pain 6/10
Electrolyte
imbalance
related to
ongoing
treatment as
evidenced by low
magnesium and
potassium levels.
short :
After 12 hours
the patient will
have serum
magnesium and
potassium with
m 2.07 k 4.15
long :
after 2
weeksThe
patient will
report an
improvement in
symptoms
related to
electrolyte
imbalance (
muscle
weakness,
cramps).
After the shift, the
patient was able
to have a higher
range levels of
magnesium and
potassium as
evidenced by lab
tests.
depended:

Assess for signs and
symptoms of electrolyte
imbalance ( muscle
cramps, weakness,
fatigue, arrhythmias).
Early detection of
symptoms allows for
prompt intervention,
preventing the progression
to severe complications.
Encourage the patient to
eat foods high in
magnesium
Dietary intake can help
replenish magnesium and
potassium levels, and
prevent further deficiencies
Educate the
patient about
the side effects
of ongoing
treatments
Understanding the relationship
between their treatment and
electrolyte imbalance will encourage
the patient to monitor symptoms and
follow dietary recommendations more
closely.
independnt :
Monitor serum electrolyte
levels (magnesium,
potassium) regularly as
ordered.
Continuous monitoring is
essential to detect and
correct imbalances in a
timely manner, as low
magnesium and potassium
can lead to serious
complications such as cardiac
arrhythmias.

14. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
Acute pain
related to
bone marrow
infiltration by
leukemia cell
and
chemotherapy
side effects
short:
after 30m the
patient will
decrease the
pain level from
6/10 to 2/10
long:
after 2 days the
patient will
demonstrate
effective pain
management
strategies and
coping
mechanisms by
discharg.
Independent:
:
Assess Pain
Regularly
Implement Non-
Pharmacological
Interventions
Educate the Patient
and Family
Encourage
Positioning for
Comfort

dependent:

Administer Pain
Medications
Use a standardized pain
scale to evaluate pain
intensity, location, and
quality at regular
intervals.
Encourage techniques
such as guided imagery,
deep breathing exercises,
and relaxation techniques
to help manage pain.
Discuss potential side
effects of chemotherapy
and pain management
strategies.
Assist the patient in
finding comfortable
positions and provide
supportive devices, such
as pillows or cushions.
Administer prescribed
analgesics
After the shift, the
patient was able to
decrease pain levels,
as evidenced by
administer prescribed
analgesics.

15. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
Activity
intolerance
related to
discomfort,
and limited
mobility due
to edema.
Short:
After 12 hours
The patient
will report a
decrease in
discomfort
during
activities
long:
After one
week The
patient will
demonstrate
increased
tolerance for
activity
Independent:
Assess Edema
Positioning
Education
Collaborate

dependent:
Pain Management
Regularly monitor
the extent and
location of edema.
Encourage frequent
changes in position
to enhance
circulation.
Provide information
on lifestyle changes
(diet, hydration) that
can help manage
edema.
Work with physical
therapy to create a
safe mobility
program
Administer
prescribed
analgesics as needed.
After the shift the
patient was able to
decrease peripheral
edema, as evidenced
by their ability to
mobilize normally.

16. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
Risk for
bleeding
related to
decreased
platelet and
clotting
factor
after 12 hours
The patient will
remain free of
bleeding
episodes during
hospitalization.
after one week
The patient will
report a
decrease in
anxiety related
to bleeding risk

Independent:
Assess for Signs of
Bleeding
Monitor Vital Signs
Implement
Bleeding
Precautions
Patient Education
Emotional Support
dependent:
Medication Review
Regularly inspect for
signs of external
bleeding ( bruising,
bleeding gums).
Check vital signs
regularly to detect any
changes that may
indicate internal bleeding
(hypotension,
tachycardia).
Use soft toothbrushes
and avoid flossing to
reduce gum bleeding.
Educate the patient and
family about avoiding
activities that could lead
to injury
Review and manage
medications that could
exacerbate bleeding (
anticoagulants, NSAIDs).
After the shift, the
patient was able to
have higher levels
of platelets as
evidenced by lab
test from 3 to 57

17. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
risk for fall
related to
weakness and
fatigue due to
low
hemoglobin
levels.
Short :
After 2 hours
the patient will
decrease level
of fall by
administering
medication
long:
after 3 days The
patient will
demonstrate
understanding
of dietary
modifications to
improve
hemoglobin
levels by
discharge.
After the shift,
the patient was
able to have a
normal level of
hemoglobin as
evidence by lab
test from 9.1 to
12.
Independent:
Encourage Gradual
Position Changes
Promote Physical
Activity
Monitor Vital Signs
Provide Nutritional
Support

dependent:
administer blood
transfusion
Advise the patient to rise
slowly from sitting or
lying positions to
prevent dizziness.
Develop a tailored
exercise program to
improve strength and
balance, such as walking
or gentle stretching.
Regularly check vital
signs, particularly blood
pressure and heart rate,
especially when the
patient changes
positions.
Encourage iron-rich foods
(red meat, leafy greens)
and vitamin C to enhance
iron absorption.

18. Assessment
Nursing
diagnosis
Expected
goals
Nursing
interventions
Ratinonales Evaluation
Risk for infection
related to
immunosuppressi
on secondary to
leukemia and it’s
chemotherapy
short :
After 12 hours
The patient
will remain
free of signs
and symptoms
of infection
during
hospitalization
.
long:
After 3 days
The patient
will verbalize
understanding
of infection
prevention
measures by
discharge.
Independent :
Monitor for Signs of
Infection
Implement Infection
Control Precautions
Patient Education
Environmental
Safety
dependent:
Medication
Management
Regularly assess vital
signs, especially
temperature for
fever.
Practice strict hand
hygiene before and
after patient contact.
Teach the patient and
family about the
importance of
handwashing and
personal hygiene.
Ensure a clean and
safe environment (
regularly disinfect
surfaces).
Administer
prophylactic
antibiotics or
antifungals as
prescribed.
After 48 hours,
the patient was
able to maintain
stable vital signs
and show no signs
of infection, as
evidenced by a
normal
temperature,
clear lung sounds,
and intact skin
with no redness
or swelling.

19. AML is a common
hematological malignancy in
adults. Despite many
advances, the malignancy still
carries a poor prognosis.
Conclusion

20. NANDA-International-Nursing-/
Diagnoses/9781684206018
https://repository.poltekkes-
kaltim.ac.id/544/1/Medical-
Surgical%20Nursing%20(%20PDFDrive.com%20).
Refrences

21. Thank you for
your attention
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