Types of Leukemia & Nursing Management
There are four main types of leukemia:
Acute myeloid leukemia (AML)
Chronic myeloid leukemia (CML)
Acute lymphocytic leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
Assessment & diagnoses
Weakness & fatigue
Possiblities of infection
All body systems examined daily - skin for petechiae. CVS : hypotension, tachycardia, dizziness, epistaxis. Pulmonary : hemoptysis, respry distress, tachypnea. GIT : hematemesis, abdominal distention, rectal bleeding. Genitourinary : vaginal or urethral bleeding. Neurologic : head ache, blurred vision, mental status changes
Impaired mucous membranes
Impaired gas exchange
Imbalanced nutrition
Pain & discomfort
Fever
Reduced physical activity
Fluid and electrolyte balance
Diarrhea
Self care deficit
Anxiety
Disturbed body image
Grief
Spiritual distress
Deficiency knowledge
Collaborative problems/ Potential complications
Infection
Bleeding
Renal dysfunction
Tumor lysis syndrome
Nutritional depletion
Mucositis
Planning and Goals
Absence of compications and pain
Adequate nutrition
Activity tolerance
Self care
Coping with the diagnosis and prognosis
Positive body image
Understanding the disease process and its treatment.
Nursing Interventions
Oral mucosa inspected - possibility of all the mucosa of the GIT being involve thouth not visible
Artificial dentures removed
Oral hygiene maintained - tooth brush soft and clean - if needed soft tipped applicators used
Saline rinses - moisture maintained - avoid antiseptics and antibiotics for fear of fungal infection
Genitalia and perinium inspected - women to clean from front to back
Stool softeners used if needed
Nutrition maintained - mouth care before and after meals - anlgesics before eating if needed - if oral anesthetics used careful chewing advised
Nausea - antiemetics
small, frequent , soft, temperature-controlled food
Uncooked food avoided
Nutritional supplements
I/O chart
Calorie counts done - if needed patenteral nutrition
Easing Pain and Discomfort
Fever, chills to be managed - acetaminophen / tepid sponging . avoid chilling
Gentle back and shoulder massage
Analgesic to relieve pain
Uninterrupted sleep to be provided
Active listening to the patient
Decreasing Fatigue and Deconditioning
Balancing between activity and rest
Mask while ambulating outside
Static cycle exercise
Encourage to sit up
Maintaining fluid and electolyte Balance
I/O chart, electrolyte levels checked and corrected; particularly K and Mg
BUN checked
Improving Self-Care
Hygienic measures if cannot be undertaken by the pt the nurse should undertake that responsibility
Empathetic listening when pt feels about inability to follow hygienic measures
Managing Anxiety and Grief
Procvide emotional support
Identify the source grief and encourage them to allow time to adjust
Advise the family about role restructuting in the family
Assurance at discharge that they will not be abandoned
Encouraging Spiritual Well-Being
Pastoral services if needed
Religious and phlosophical teachings
Promoting Home and Community-Based care
Patient's family and friends taught how to behave with the patient
Self care and family care at home taught
Continuing Care
IV line may be needed at home for administration of drugs
Monitoring of the IV sites and other parmeters are taught to the pt and family
Expected Patient Outcomes
No evidence of infection
No bleeding
Intact oral mucous membrane
Optimum nutrition
Pain relief
Less fatigue and more activity
Balanced fluid and electrolyte levels
Participation in self-care
Coping with anxiety and grief
Absence of complications
