Nursing Care Plans for Leukemias
Comprehensive Guide for Nursing Students
Introduction to 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.
Classifications of Leukemia
Leukemia is classified according to the rate at which the condition progresses and whether the leukemia cells come from lymphoid or myeloid cells:
By disease progression rate:
- Acute Leukemia: Cells divide fast, advances rapidly, needs aggressive management, most common in children
- Chronic Leukemia: Cells behave as mature yet dysfunctional blood cells, progresses slowly, may have a watch and wait approach, more common in adults
By type of affected cell:
- Myelogenous or myeloid leukemia: Originates from myeloid cells (red blood cells, white blood cells except lymphocytes, and platelets)
- Lymphocytic leukemia: Originates from lymphoid cells (white blood cells/lymphocytes)
Common Types of Leukemia
- Acute Lymphocytic Leukemia (ALL): Most common in children, characterized by rapid proliferation of immature lymphocytes in bone marrow
- Acute Myelogenous Leukemia (AML): Most common acute form in adults, characterized by uncontrolled proliferation of myeloblasts
- Chronic Lymphocytic Leukemia (CLL): Most common chronic type in older adults, characterized by production of functionally inactive mature-appearing lymphocytes
- Chronic Myelogenous Leukemia (CML): Occurs mainly in adults, may not show early symptoms
Table of Contents
- Nursing Diagnosis: Risk for Infection
- Nursing Diagnosis: Acute Pain
- Nursing Diagnosis: Fatigue
- Nursing Diagnosis: Risk for Bleeding
- Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements
- Nursing Diagnosis: Activity Intolerance
- Nursing Diagnosis: Risk for Decreased Cardiac Output
- Nursing Diagnosis: Risk for Impaired Skin Integrity
- Nursing Diagnosis: Anxiety
- Nursing Diagnosis: Ineffective Coping
- Nursing Diagnosis: Deficient Knowledge
- Nursing Diagnosis: Risk for Imbalanced Fluid Volume
- Home Care Advice for Leukemia Patients
Leukemia Nursing Care Plans
The following nursing care plans are designed to address the unique needs of patients with leukemia. Each plan includes a nursing diagnosis, related factors, defining characteristics, expected outcomes, and nursing interventions with rationales.
1. Nursing Diagnosis: Risk for Infection
Related Factors/Risk Factors:
- Inadequate secondary defenses (alterations in mature WBCs, low granulocyte count)
- Immunosuppression from disease process
- Bone marrow suppression (effects of chemotherapy)
- Inadequate primary defenses (stasis of body fluids, traumatized tissue)
- Invasive procedures
- Malnutrition
Expected Outcomes:
- Patient will remain free from signs and symptoms of infection
- Patient will identify actions to prevent/reduce risk of infection
- Patient will demonstrate techniques and lifestyle changes to promote a safe environment
- Patient will maintain normal temperature
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Closely monitor temperature. Note correlation between temperature elevations and chemotherapy treatments. | Although fever may accompany some forms of chemotherapy, progressive hyperthermia occurs in some types of infections. Fever unrelated to drugs or blood products occurs in most leukemia patients. Septicemia may occur without fever. |
| 2. Place in a private room. Limit visitors as indicated. Prohibit live plants or flowers. | To protect the patient from potential sources of pathogens or infection. Bone marrow suppression and neutropenia place the patient at high risk for infection. |
| 3. Require good hand washing protocol for all personnel and visitors. | Prevents cross-contamination and reduces the risk of infection. |
| 4. 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. |
| 5. Auscultate breath sounds, noting crackles and rhonchi. Observe urine for signs of infection. | Early intervention is essential to prevent sepsis in immunosuppressed persons. |
| 6. Monitor laboratory studies (WBC, neutrophil count, cultures). | Helps identify infection risk and determines appropriate interventions. |
| 7. Avoid using indwelling urinary catheters and giving I.M. injections. | These can provide an avenue for infection. |
| 8. Change IV tubing according to facility’s policy. Use strict sterile technique. | Minimizes the risk of infection and ensures proper medication delivery. |
2. Nursing Diagnosis: Acute Pain
Related Factors:
- Physical agents (bone or joint involvement)
- Chemical agents (chemotherapy, radiation therapy)
- Tissue damage from disease process
- Psychological manifestations (anxiety, fear)
Defining Characteristics:
- Verbal reports of pain (bone, nerve, headaches)
- Guarding/distraction behaviors
- Facial grimacing, alteration in muscle tone
- Autonomic responses (changes in vital signs)
Expected Outcomes:
- Patient will report a reduced pain level following pain management interventions
- Patient will verbalize effective non-pharmacologic pain management strategies
- Patient will demonstrate relaxed posture and ability to rest/sleep appropriately
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Investigate reports of pain. Note changes in degree (use a scale of 0-10) and site. | Helpful in assessing the need for intervention; may indicate developing complications. |
| 2. Monitor vital signs and note nonverbal cues (muscle tension, restlessness). | May be useful in evaluating verbal comments and effectiveness of interventions, especially in pediatric patients who may not verbalize pain clearly. |
| 3. Monitor uric acid level as appropriate. | Rapid turnover and destruction of leukemic cells during chemotherapy can elevate uric acid, causing swollen painful joints in some patients. |
| 4. Provide a quiet environment and reduce stressful stimuli. Limit noise, lighting, and constant interruptions. | Promotes rest and enhances coping abilities. |
| 5. Place in a position of comfort and support joints and extremities with pillows or padding. | May decrease associated bone or joint discomfort. |
| 6. Provide comfort measures (massage, heat or cool packs) and psychological support. | Minimizes need for or enhances effects of medication. |
| 7. Encourage diversional and relaxation activities such as guided imagery, deep breathing exercises, or mindfulness meditation. | These activities can help distract attention from pain and promote relaxation and a sense of well-being, reducing pain intensity. |
| 8. Administer analgesics as prescribed, monitoring effects and side effects. | Provides pain relief while minimizing adverse effects. Avoid aspirin-containing products due to bleeding risk. |
3. Nursing Diagnosis: Fatigue
Related Factors:
- Disease process (leukemia)
- Anemia
- Treatment effects (chemotherapy, radiation)
- Pain
- Malnutrition
- Psychological stress
Defining Characteristics:
- Verbal reports of fatigue or weakness
- Exertional discomfort or dyspnea
- Inability to maintain normal routines
- Decreased performance
- Lethargy or listlessness
- Increased physical complaints
- Emotional lability or irritability
Expected Outcomes:
- Patient will demonstrate ways to increase energy and improve activity tolerance
- Patient will report a boost in energy and ability to perform activities
- Patient will establish a balance between activity and rest
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Assess the severity of fatigue using a scale (0-10). | Cancer-related fatigue is a common symptom in patients with leukemia. Proper assessment is critical as it can adversely affect health-related quality of life. |
| 2. Monitor laboratory values (hemoglobin, hematocrit, electrolytes). | Identifies underlying physical causes like anemia or electrolyte imbalances that contribute to fatigue. |
| 3. Encourage the patient to express feelings about fatigue. | Allows patients to verbalize feelings about the disease process, helping set realistic goals and maintain a sense of control. |
| 4. Provide quiet environment and uninterrupted rest periods. Encourage rest before meals. | Restores energy needed for activity and cellular regeneration or tissue healing. |
| 5. Implement energy-saving techniques (sitting rather than standing, pacing activities, using a shower chair). | Maximizes available energy for self-care tasks. |
| 6. Encourage planned exercise activities based on energy levels. | Continued physical activity after chemotherapy is associated with improved physical, social, and mental functioning and promotes a better quality of life. |
| 7. Discuss mental health support options. | Counseling may help with understanding and coping with the loss of energy. A therapist can offer strategies to manage brain fog. |
| 8. Administer blood products as ordered. | Improves oxygen-carrying capacity and may reduce fatigue related to anemia. |
4. Nursing Diagnosis: Risk for Bleeding
Related Factors/Risk Factors:
- Thrombocytopenia due to bone marrow invasion by leukemic cells
- Bone marrow suppression from chemotherapy
- Disseminated intravascular coagulation (DIC)
- Invasive procedures
Expected Outcomes:
- Patient will not experience excessive bleeding
- Patient will demonstrate knowledge of bleeding precautions
- Patient will maintain stable vital signs
- Patient will report and recognize signs of bleeding promptly
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Monitor laboratory studies: platelets, Hb/Hct, clotting factors. | When the platelet count is less than 20,000/mm³, the patient is prone to spontaneous life-threatening bleeding. Decreasing Hb/Hct indicates bleeding (may be occult). |
| 2. Implement bleeding precautions: avoid invasive procedures, use soft toothbrush, avoid constipation, avoid aspirin-containing products. | Minimizes trauma that could lead to bleeding, especially when platelets are low. |
| 3. Inspect for evidence of bleeding: petechiae, ecchymosis, hematuria, hematemesis, melena, bleeding gums, epistaxis. | Early detection allows for prompt intervention. |
| 4. Apply pressure to venipuncture sites for at least 5 minutes. | Promotes clotting and prevents hematoma formation. |
| 5. Handle patient gently during transfers and positioning. Keep side rails padded. | Prevents injury and bruising due to fragile capillaries and decreased platelet count. |
| 6. Avoid rectal temperatures, suppositories, enemas, and rectal examinations. | Prevents trauma to rectal mucosa and potential bleeding. |
| 7. Maintain external central vascular access device when possible. | Eliminates peripheral venipuncture as a source of bleeding. |
| 8. Administer blood products (platelets, fresh frozen plasma) as ordered. | Replaces clotting factors and platelets to prevent or treat hemorrhage. |
5. Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements
Related Factors:
- Increased metabolic demands (disease process)
- Anorexia related to disease and treatment
- Nausea and vomiting from chemotherapy
- Stomatitis, mucositis (side effects of treatment)
- Taste alterations from medication
- Fatigue
Defining Characteristics:
- Weight loss
- Food intake less than body requirements
- Poor muscle tone
- Altered taste sensation
- Lack of interest in food
- Sore, inflamed buccal cavity
Expected Outcomes:
- Patient will maintain or improve nutritional intake
- Patient will demonstrate stable weight or begin weight gain toward goal
- Patient will identify factors that affect nutrition and ways to overcome them
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Assess nutritional status: monitor weight, dietary intake, lab values (albumin, protein, lymphocyte count). | Provides baseline data and identifies specific nutritional deficits. |
| 2. Schedule meals around chemotherapy. Give oral hygiene before meals and administer antiemetics as indicated. | May enhance intake by reducing nausea. Oral hygiene removes bad tastes that can decrease appetite. |
| 3. Recommend small, nutritious, high-protein meals and snacks throughout the day. | Smaller meals require less energy for digestion than larger meals. Increased protein intake provides fuel for energy and tissue repair. |
| 4. Provide oral care before and after meals using soft-bristled toothbrush or foam swabs. | Keeps mouth clean, prevents infection, and improves taste perception. Soft tools prevent trauma to fragile mucosa. |
| 5. Offer nutritional supplements between meals. | Increases caloric and protein intake when regular meals are not tolerated well. |
| 6. Create a pleasant environment for meals. Encourage family to bring favorite foods from home if appropriate. | Environmental factors affect appetite. Familiar foods may be more appealing. |
| 7. Consult with dietitian for individualized nutritional plan. | Specialist can recommend appropriate calorie and protein requirements based on patient’s condition. |
| 8. Consider alternative feeding methods (enteral or parenteral nutrition) if patient cannot maintain adequate oral intake. | Ensures nutritional needs are met when oral intake is insufficient. |
6. Nursing Diagnosis: Activity Intolerance
Related Factors:
- Generalized weakness from disease process
- Anemia resulting from bone marrow suppression
- Therapeutic restrictions (isolation, treatment protocols)
- Reduced energy/oxygen transport due to anemia
- Pain
- Fatigue
Defining Characteristics:
- Verbal report of fatigue or weakness
- Abnormal heart rate or blood pressure response to activity
- Exertional discomfort or dyspnea
- Difficulty performing routine activities
Expected Outcomes:
- Patient will participate in necessary/desired activities without excessive fatigue
- Patient will demonstrate understanding of balance between activity and rest
- Patient will show improved tolerance to activity as evidenced by normal vital signs during activity
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Evaluate reports of fatigue, noting inability to participate in activities or ADLs. | Effects of leukemia, anemia, and chemotherapy may be cumulative, necessitating assistance. |
| 2. Monitor and record vital signs and oxygen saturation levels before, during, and after activity. | Provides objective data about activity tolerance and guides appropriate activity progression. |
| 3. Assess client for signs of dyspnea or chest pain during activity. | Decreased physical activity can lead to deconditioning, causing dyspnea, while anemia can lead to chest pain due to inadequate oxygen supply. |
| 4. Encourage patient to keep a diary of daily routines and energy levels, noting activities that increase fatigue. | Helps patient prioritize activities and arrange them around fatigue pattern. |
| 5. Plan activities for periods when patient has the most energy. | Maximizes patient’s ability to participate and minimizes fatigue. |
| 6. Encourage moderate exercises as indicated (guided stretching, short walks, light resistance training). | Helps enhance cardiovascular and muscular endurance, promotes balance and flexibility, and improves overall functional capacity. |
| 7. Provide assistive devices as needed (walker, wheelchair). | Conserves energy while allowing continued mobility. |
| 8. Provide supplemental oxygen as indicated. | Maximizes oxygen available for cellular uptake, improving tolerance of activity in anemic patients. |
7. Nursing Diagnosis: Risk for Decreased Cardiac Output
Related Factors/Risk Factors:
- Cancer cells infiltrating cardiac cells
- Inadequate oxygenated blood to the heart (anemia)
- Inflammation
- Immunosuppression
- Cancer treatments (anthracyclines)
- Fluid volume imbalances
Expected Outcomes:
- Patient will not develop signs of heart failure, endocarditis, or pericarditis
- Patient will display normal sinus rhythm on ECG
- Patient will verbalize strategies to prevent developing heart disease
- Patient will maintain adequate cardiac output as evidenced by stable vital signs and normal tissue perfusion
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Monitor if patient is taking anthracyclines (such as doxorubicin). Observe for signs of cardiac toxicity (changes in BP, activity intolerance, dyspnea, chest pain, palpitations, edema). | Anthracyclines are a class of drugs used in chemotherapy that have been shown to damage cardiac cells and the pumping ability of the heart. |
| 2. Review echocardiogram results and other cardiac testing. | An echocardiogram can assess the left ventricular ejection fraction and the patient’s risk of developing heart failure. |
| 3. Obtain ECG as indicated. | If the client has a history of heart disease or presents with cardiac symptoms, an ECG can monitor for dysrhythmias. |
| 4. Discuss lower doses of anthracyclines if cardiac symptoms develop. | If the patient begins experiencing heart-related side effects from these medications, lowering doses or switching to a different medication may be warranted. |
| 5. Refer to a cardiologist as needed. | Multidisciplinary approach is important; it may be prudent to involve a cardiologist if cardiac issues arise. |
| 6. Administer prescribed cardiac medications (ACE inhibitors, beta-blockers, diuretics) as ordered. | Treats manifestations of heart failure such as hypertension and edema. |
| 7. Educate on lifestyle modifications to prevent heart disease (exercise, smoking cessation, healthy diet). | The patient is still in control of keeping their heart as healthy as possible while undergoing treatment for leukemia. |
| 8. Monitor vital signs, especially heart rate and blood pressure. | Changes may indicate cardiac compromise and need for intervention. |
8. Nursing Diagnosis: Risk for Impaired Skin Integrity
Related Factors/Risk Factors:
- Immunosuppression
- Effects of radiation and chemotherapy
- Altered nutritional status
- Prolonged bed rest/immobility
- Edema
- Thrombocytopenia leading to easy bruising
Expected Outcomes:
- Patient will maintain intact skin throughout treatment
- Patient will demonstrate knowledge of skin care practices
- Patient will verbalize signs/symptoms of skin breakdown to report
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Assess skin daily for color, temperature, sensation, edema, and integrity. | Early detection of skin problems allows for prompt intervention. |
| 2. Keep skin clean and dry. Use mild soap and apply moisturizer to dry skin. | Prevents breakdown from excessive dryness without compromising skin integrity. |
| 3. Reposition at least every 2 hours if mobility is limited. | Prevents pressure injury development by redistributing pressure. |
| 4. Use pressure-reducing devices (special mattresses, heel/elbow protectors). | Reduces pressure on bony prominences and decreases risk of pressure injuries. |
| 5. Provide skin care after radiation. Moisturize area after (not before) treatment. | Redness and irritation are normal after radiation therapy. Proper care minimizes skin reaction. |
| 6. Handle the patient gently. Keep linens dry and wrinkle-free. | Prevents sheet burn and skin excoriation. |
| 7. Encourage adequate nutrition and hydration. | Supports skin health and healing. |
| 8. Monitor for and promptly treat oral mucositis with appropriate mouth care regimen. | Oral tissues are particularly vulnerable to breakdown during chemotherapy. |
9. Nursing Diagnosis: Anxiety
Related Factors:
- Threat to self-concept (change in role, body image)
- Situational crisis (diagnosis of life-threatening illness)
- Threat to health status
- Knowledge deficit about disease process and treatment
- Fear of death
- Uncertainty about prognosis
Defining Characteristics:
- Expressed concerns about treatment outcomes
- Increased tension
- Apprehension
- Restlessness
- Focus on self
- Insomnia
- Increased heart rate and blood pressure
Expected Outcomes:
- Patient will verbalize reduced anxiety
- Patient will demonstrate effective coping strategies
- Patient will show physiologic signs of decreased anxiety (normal vital signs, relaxed posture)
- Patient will express understanding of disease process and treatment plan
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Establish a therapeutic relationship through active listening and empathetic presence. | Creates a foundation of trust that allows the patient to express fears and concerns. |
| 2. Assess level and source of anxiety using standardized tools when appropriate. | Identifies specific triggers to address and helps gauge effectiveness of interventions. |
| 3. Provide accurate, understandable information about disease, treatment options, procedures, and expected sensations. | Knowledge helps reduce fear of the unknown and gives the patient a sense of control. |
| 4. Encourage expression of feelings, concerns, and questions. | Verbalization of fears can reduce their intensity and help the patient gain perspective. |
| 5. Teach anxiety-reducing techniques (deep breathing, progressive muscle relaxation, guided imagery, meditation). | Gives patient tools to self-manage anxiety symptoms. |
| 6. Include family/support persons in discussions and education when appropriate. | Family members can reinforce teaching and provide emotional support. |
| 7. Create a calm, quiet environment with minimal disruptions. | Environmental stimuli can increase anxiety; a peaceful setting promotes relaxation. |
| 8. Administer anxiolytic medications as prescribed and monitor effectiveness. | Medication may be necessary for moderate to severe anxiety that interferes with functioning or well-being. |
10. Nursing Diagnosis: Ineffective Coping
Related Factors:
- Situational crisis (cancer diagnosis)
- Personal vulnerability
- Inadequate social support
- Uncertainty about prognosis and treatment outcomes
- Multiple stressors (physical symptoms, treatment demands, financial concerns)
Defining Characteristics:
- Verbalization of inability to cope or ask for help
- Ineffective problem-solving
- Inability to meet role expectations
- Decreased use of social support
- Altered social participation
- High illness/treatment-related distress
Expected Outcomes:
- Patient will identify effective coping strategies
- Patient will verbalize increased ability to manage stressors
- Patient will utilize appropriate resources and support systems
- Patient will demonstrate problem-solving abilities to manage illness-related challenges
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Establish a trusting relationship to promote communication. | A therapeutic relationship creates a safe environment for patients to express feelings and concerns. |
| 2. Assess current coping mechanisms and previous successful coping strategies. | Builds on patient’s existing strengths and identifies areas for development. |
| 3. Allow the patient and family to discuss or verbalize their anger, depression, and grief. | Acknowledging and expressing emotions is a necessary part of adapting to life-changing diagnosis. |
| 4. Encourage patient to identify priorities and set realistic goals. | Helps focus energy on what matters most and provides a sense of control and purpose. |
| 5. Teach stress management techniques and encourage their use. | Provides concrete tools for managing emotional responses to stressors. |
| 6. Refer to support groups specific to leukemia patients. | Connecting with others who have similar experiences reduces isolation and provides practical coping strategies. |
| 7. Include family members in care planning and encourage their participation when appropriate. | Family involvement strengthens the patient’s support system and helps family members cope with their own stress. |
| 8. Refer to mental health professionals (psychologist, social worker) when indicated. | Professional counseling may be necessary when adjustment difficulties persist or interfere with treatment adherence. |
11. Nursing Diagnosis: Deficient Knowledge
Related Factors:
- Lack of exposure or recall
- Information misinterpretation
- Unfamiliarity with information resources
- Cognitive limitation
- Anxiety interfering with learning
Defining Characteristics:
- Verbalization of the problem or request for information
- Statement of misconception
- Inaccurate follow-through of instruction
- Inappropriate or exaggerated behaviors (hysterical, hostile, agitated, apathetic)
Expected Outcomes:
- Patient will verbalize understanding of leukemia, its treatment, and self-care measures
- Patient will demonstrate necessary skills for self-care
- Patient will identify signs and symptoms requiring medical attention
- Patient will adhere to treatment regimen
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Assess current knowledge level, learning needs, and preferred learning style. | Tailors education to individual needs and capabilities, increasing effectiveness. |
| 2. Review pathology of the specific form of leukemia and treatment options. | Understanding the disease process helps patients make informed decisions about their care. |
| 3. Provide information in multiple formats (verbal, written, visual aids, demonstrations). | Different learning formats reinforce understanding and accommodate different learning styles. |
| 4. Explain purpose and side effects of medications, focusing on self-management strategies. | Knowing what to expect and how to manage side effects increases adherence and quality of life. |
| 5. Teach signs and symptoms that require immediate medical attention (fever, bleeding, severe pain). | Early recognition and intervention for complications can prevent serious outcomes. |
| 6. Involve family members or support persons in education sessions. | Support persons can reinforce teaching and assist with care at home. |
| 7. Validate understanding through teach-back technique. | Having patients explain concepts in their own words reveals areas needing clarification. |
| 8. Provide information about available community resources and support groups. | Connects patients to ongoing sources of information and support beyond the healthcare setting. |
12. Nursing Diagnosis: Risk for Imbalanced Fluid Volume
Related Factors/Risk Factors:
- Cancer treatment side effects (chemotherapy)
- Presence of infection or sepsis
- Blood transfusions
- Kidney injury
- Presence of cardiovascular/renal conditions
- Nausea, vomiting, diarrhea
- Tumor lysis syndrome
Expected Outcomes:
- Patient will maintain balanced fluid intake and output
- Patient will not display signs of imbalanced fluid volume (edema, changes in mental status, hypotension, shortness of breath, dry mucous membranes)
- Patient will maintain hemoglobin, hematocrit, and electrolytes within normal limits
- Patient will verbalize understanding of fluid balance monitoring
Nursing Interventions and Rationales:
| Interventions | Rationales |
|---|---|
| 1. Strictly monitor fluid intake and output. Ensure accurate documentation each shift. | Fluid balance is calculated by comparing intake to output. Provides early indication of developing fluid imbalance. |
| 2. Weigh daily at the same time, using the same scale, with similar clothing. | Provides a measure of the adequacy of fluid replacement and kidney function. Rapid weight changes often reflect fluid status changes. |
| 3. Monitor vital signs, especially blood pressure and heart rate. | Changes may reflect the effects of hypovolemia (bleeding or dehydration) or hypervolemia (fluid overload). |
| 4. Evaluate skin turgor, capillary refill, and condition of mucous membranes. | These are indirect indicators of hydration status. |
| 5. Monitor laboratory studies: electrolytes, BUN, creatinine, hemoglobin, hematocrit. | Abnormal values may indicate fluid imbalance or developing kidney complications. |
| 6. Control symptoms that cause fluid loss (administer antiemetics, antidiarrheals, antipyretics as ordered). | Vomiting, diarrhea, and fever contribute to fluid losses and dehydration. |
| 7. Encourage fluids up to 3-4 L/day when oral intake is possible and not contraindicated. | Promotes urine flow, prevents uric acid precipitation, and enhances clearance of antineoplastic drugs. |
| 8. Administer IV fluids as ordered, monitoring infusion rate carefully. | Maintains fluid and electrolyte balance in the absence of adequate oral intake; prevents or minimizes tumor lysis syndrome. |
Home Care Advice for Leukemia Patients
Infection Prevention
- Wash hands frequently with soap and water, especially before eating and after using the bathroom
- Avoid contact with people who have colds, flu, or other contagious illnesses
- Avoid crowded places during flu season or when neutrophil counts are low
- Clean and disinfect frequently touched surfaces in the home regularly
- Do not share personal items like toothbrushes, razors, or towels
- Take prescribed prophylactic antibiotics exactly as directed
- Shower daily and practice good personal hygiene
- Do not handle pet waste; have someone else clean litter boxes or pick up after dogs
- Use a soft toothbrush for oral care and avoid dental floss if platelet count is low
- Take temperature at least once daily and report any fever (100.4°F/38°C or higher) immediately
Nutrition and Hydration
- Eat a balanced diet high in protein and calories to support healing
- Cook all foods thoroughly to eliminate bacteria; avoid raw or undercooked meats, eggs, and seafood
- Wash all fruits and vegetables thoroughly before eating or peeling them
- Avoid salad bars, buffets, and street food where food may sit at unsafe temperatures
- Use separate cutting boards for raw meat and vegetables
- Drink 8-10 glasses of fluid daily unless otherwise instructed
- Eat small, frequent meals if appetite is poor
- Take nutritional supplements as recommended by healthcare team
- Avoid alcohol, as it can interfere with medications and suppress immune function
- Store foods at proper temperatures and discard leftovers after 2-3 days
Managing Fatigue and Activity
- Plan activities during times of day when energy levels are highest
- Balance rest periods with activity throughout the day
- Prioritize activities and delegate tasks when possible
- Use energy conservation techniques (sitting instead of standing for tasks, using assistive devices)
- Engage in light exercise as tolerated and approved by healthcare provider
- Take short naps (30-60 minutes) during the day if needed
- Maintain a regular sleep schedule
- Ask for help with household chores, shopping, and transportation
- Keep a journal to track energy patterns and identify activities that increase fatigue
- Consider occupational therapy for advice on energy conservation techniques
Bleeding Precautions
- Use an electric razor instead of a blade to prevent cuts
- Use a soft toothbrush to avoid gum bleeding
- Avoid activities with high risk of injury (contact sports, climbing ladders)
- Apply pressure to any cut or puncture for at least 5 minutes
- Avoid blowing nose forcefully
- Avoid constipation by drinking fluids, eating fiber, and using stool softeners if needed
- Do not take aspirin or NSAIDs unless specifically approved by oncologist
- Wear protective gloves when gardening or doing housework
- Remove throw rugs and secure electrical cords to prevent falls
- Report any unusual bleeding or bruising to healthcare provider immediately
Medication Management
- Take all medications exactly as prescribed
- Use a pill organizer to help keep track of medications
- Do not crush or break tablets unless instructed to do so
- Store medications at proper temperature and away from direct sunlight
- Keep a current list of all medications, including over-the-counter drugs and supplements
- Do not take any new medications, herbs, or supplements without consulting healthcare provider
- Report any side effects or concerns about medications promptly
- Ensure adequate supply of medications, especially before weekends or holidays
- Dispose of unused medications properly
- Set reminders for medication times if needed
When to Seek Medical Attention
- Temperature of 100.4°F (38°C) or higher
- Shaking chills
- Bleeding that doesn’t stop after applying pressure for 5 minutes
- Blood in urine, stool, or vomit
- New onset of pain or pain not controlled by prescribed medications
- Shortness of breath or difficulty breathing
- Persistent nausea, vomiting, or diarrhea
- Rash or unusual skin changes
- Confusion or changes in mental status
- Dizziness, extreme fatigue, or fainting
Emotional Well-being
- Connect with support groups for leukemia patients and caregivers
- Practice stress reduction techniques such as deep breathing, meditation, or gentle yoga
- Maintain social connections and communicate your needs to family and friends
- Consider professional counseling if experiencing persistent anxiety or depression
- Set realistic goals and celebrate small victories in your recovery process
- Keep a journal to express feelings and track your progress
- Engage in enjoyable activities and hobbies that are comfortable within your energy levels
- Establish a daily routine to provide structure and normalcy
- Focus on aspects of life you can control rather than those you cannot
- Accept help when offered and ask for it when needed
Important Note for Nursing Students:
The nursing care plans presented in this guide are educational templates and should be customized to each patient’s unique situation. Always assess your specific patient’s needs and consult with experienced healthcare providers when implementing care plans in clinical practice.
Study Tip:
When studying these care plans, try to visualize yourself implementing each intervention with a real patient. Think about how you would adapt each care plan based on different types of leukemia, patient ages, and treatment protocols. This approach will help you build critical thinking skills essential for nursing practice.