Nursing Care Plan (NCP) for Leukemia

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Hey Guys, let's take a look at the care plan for leukemia. In this lesson, we'll briefly take a look at the pathophysiology and etiology of leukemia. We'll also take a look at additional things like subjective and objective data, as well as nursing interventions and rationales. 

 

So leukemia is cancer of the blood forming tissues, and usually involves the white blood cells. The bone marrow produces abnormal white blood cells that do not function properly. The life cycle of the white blood cell is changed and the cells do not die when they should, thus they accumulate and take up space. So the non-functioning cells crowd out the good cells, which impairs the growth and function of the healthy cells. There are many types of leukemia, so some types can be cured while others cannot. Treatment is going to be highly dependent on the type of leukemia. Scientists don't fully know the exact etiology of the disease. It's believed that it may come from a combination of environmental and genetic factors, genetics, radiation, or chemical exposure, viruses like HIV, previous chemotherapy, and those with down syndrome appear to have a higher incidence of leukemia. 

 

The desired outcome is to minimize complications and resolve if possible, maximize the number of those normal blood cells and minimize the abnormal blood cells. Let's take a look at the subjective and objective data that your patient with leukemia may present with. Remember,  subjective data are going to be things that are based on your patient's opinions or feelings. These things may include loss of appetite, weight loss, the tendency to bruise or bleed, fatigue, weakness, and bone pain. 

 

Objective data may include frequent infections, fever, swollen lymph nodes, enlarged liver, or spleen, petechiae, recurrent nosebleeds, prolonged clotting factors, elevated white blood cells, and pallor. 

 

Let's take a look at the nursing interventions necessary when caring for a patient with leukemia.  It is extremely important to initiate bleeding precautions as clotting factors in leukemia patients are impaired and patients are at a higher risk of bleeding and bruising. So, assess any pain in your patient's. Pain can be difficult to control and manage and pain medications may only be scheduled as PRN for breakthrough pain. So, other interventions like massage, repositioning, or positioning, cool and heat therapy, aroma therapy, guided imagery may be helpful in addition to medication for more comprehensive pain control. Make sure the intervention is appropriate for the patient and also avoid extra stressors. Especially during treatment, patients are at a higher risk for developing sepsis, so monitor closely for signs and symptoms of infection and notify the provider. Also progressive hyperthermia may occur as the body's response to the disease and the effects of treatment, so monitor your patient's temperature closely, especially during chemo.  Try your best to anticipate the needs of your patient, meaning time pain and nausea medications at their peak according to therapy, chemo, and meal times to increase effectiveness. 

 

Dehydration and kidney compromise is a potential complication of disease and treatment, so monitor for signs of dehydration, hydration, including skin turgor, dry mucous membranes, and capillary refill, and encourage hydration in your patient and monitor closely.  Patients and family members must be knowledgeable in the disease process as well as what to expect to help reduce anxiety, and also to be prepared for complications as they arise. 

 

Educate the patient, family and caregivers of the importance of helping reduce the risk of infection for the patient by practicing good hand hygiene. Certain procedures like catheter insertion, injections, lines, and tubes, things that we as providers may take for granted as simple or low risk procedures, need to be thought of as risk versus benefit for leukemia patients. These patients have a lack of sufficient white blood cells that damages the immune system and makes the patient more prone to infections even with the most basic of procedures. So, with leukemia patients, fatigue is a super common symptom which may make it difficult for the patient to participate in self care. Provide assistance with ADL's as needed and cluster care to reduce fatigue and promote rest. Prioritize activities to help conserve their energy for self care. 

 

Here is a look at the completed care plan for leukemia. Okay guys, that's it for this lesson. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 
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