Leukemia and Nursing Care

Leukemia and Nursing Care

• Implementation nurses are integral to multidisciplinary care of leukemia patients.
• Leukemia diagnosis and treatment significantly impact both the patient and their family.
• Patients and their families may benefit from support groups and social services.
• Induction therapy often starts in the hospital, requiring 3-4 weeks of hospitalization.
• Consolidation therapy may allow for oral medication administration at home.
• Nursing assessments of the family address nutrition, sleep, medication administration, and psychosocial support.
• Family teaching ensures safe drug administration and identifies areas for further instruction.

Managing Adverse Medication Effects

• Nurses monitor patients receiving leukemia treatment for adverse medication effects.
• Daily weight measurements assess hydration and nutritional status.
• Infusion sites are monitored for extravasation, especially with chemotherapy agents.
• Intake and output monitoring assess kidney function and fluid balance.
• Increased fluid intake (3000 mL/day) is crucial for patients receiving cyclophosphamide to prevent hemorrhagic cystitis.
• Medications like allopurinol and diuretics are administered as ordered.

Infection Prevention

• Infection is a leading cause of death in leukemia patients.
• WBC dysfunction impairs the immune and inflammatory responses.
• Mucous membranes are vulnerable to breakdown and infection due to chemotherapy or radiation.
• Chemotherapy or radiation therapy contributes to bone marrow suppression, increasing infection risk.

Bleeding Prevention

• Bleeding is the second most common cause of leukemia deaths.
• Reduced platelet counts increase bleeding risk.
• Early identification of bleeding is crucial to prevent significant blood loss and potential shock.
• Patients should avoid activities that can damage mucous membranes, such as forceful nose blowing or coughing.
• Monitoring blood levels of electrolytes, uric acid, urea nitrogen, and creatinine is essential.
• Invasive procedures are avoided or delayed when platelet counts are low.
• Pressure application at injection sites helps prevent prolonged bleeding.

Nursing Care Plan: Patient with AML

• Catherine Cole, a 37-year-old secretary, is admitted for a bone marrow biopsy.
• Ms. Cole presents with fatigue, night sweats, bruising, and heavy menstrual bleeding.
• Physical assessment reveals petechiae, ecchymoses, oral ulcerations, and abnormal blood count results.
• A tentative diagnosis of AML is made.

Nursing Diagnoses

• Risk of infection related to altered WBC production and immune function
• Potential for bleeding
• Potential for disrupted integrity of oral mucous membranes secondary to anemia and reduced platelets
• Fatigue related to anemia
• Anxiety related to fear of leukemia diagnosis

Planning

• The patient will remain free of infection.
• The patient will experience no significant bleeding.
• The patient will have intact oral mucous membranes.
• The patient will manage self-care activities despite fatigue.
• The patient will verbalize decreased anxiety.

Implementation

• Private room placement with limited visitors.
• Strict hand hygiene protocols for staff, family, and the patient.
• Vital signs monitoring every 4 hours.
• Avoiding invasive procedures unless absolutely necessary.
• Frequent monitoring for bleeding (skin, oral mucosa, abdominal assessment, body fluids).
• Regular oral hygiene with soft-bristled toothbrush.
• Dietary consultation to identify preferred foods and avoid oral mucosa irritants.
• Rest periods alternating with activity.
• Education about the bone marrow biopsy, allowing time for questions and expression of fears.
• Referral to oncology nurse specialist for further teaching and support.

Evaluation

• The bone marrow biopsy confirms AML.
• Ms. Cole expresses anxiety but participates in discussions about treatment plans.
• She chooses outpatient chemotherapy.
• During hospitalization, Ms. Cole remains free of infection and significant bleeding.
• She reports improvement in oral discomfort.
• Ms. Cole expresses reduced anxiety, acknowledging that knowing the diagnosis offers relief.

Critical Thinking

• Altered WBCs impair immune and inflammatory responses, increasing susceptibility to infection.
• Potential sources of infection in a hospitalized patient include:
  • Staff and visitors
  • Equipment, instruments, and surfaces
  • Air
  • Food and water
  • Other patients
• Encouraging self-care, including oral and physical hygiene, promotes independence and reinforces infection control practices.
• Home care teaching for infection prevention includes:
  • Strict hand hygiene
  • Avoiding contact with sick individuals
  • Keeping vaccinations up to date
  • Proper food handling and preparation
  • Maintaining a clean living environment
• Care plan for Ms. Cole's inability to tolerate activity includes:
  • Adequate rest periods
  • Assisting with daily activities
  • Providing support and encouragement
  • Considering assistive devices
  • Encouraging pacing of activities
  • Evaluating and adjusting the plan as needed.

This quiz explores the role of nursing care in managing leukemia patients, focusing on both the medical and emotional support needed for patients and their families. It covers topics such as induction and consolidation therapy, adverse medication effects, and family teaching. Test your knowledge on how nursing practices can impact patient outcomes in leukemia care.