Leukemia Nursing Care Plans Diagnosis and Interventions
Leukemia NCLEX Review and Nursing Care Plans
Leukemia is a medical condition that involves the cancer of the blood-forming tissues of the body, which include the bone marrow and the lymphatic system. It is a blood cancer that can be acute or chronic in nature.
Some types of leukemia are more commonly found in children, while other forms are usually seen in adults. Currently, there is no absolute cure for leukemia.
However, the treatment plans for leukemia are being rapidly developed in the past few decades. These have shown promising results in terms of the overall increase in survivorship and improvement of the quality of life for patients.
Signs and Symptoms of Leukemia
Each type of leukemia may have varying signs and symptoms. Generally, leukemia patients have the following clinical manifestations:
- Fever or chills
- Bone pain or tenderness
- Swollen lymph nodes, enlarged liver or spleen
- Persistent fatigue
- Malaise or generalised body weakness
- Moderate to severe infections which may be recurrent
- Unexplained or unintentional weight loss
- Recurrent nosebleeds
- Tendency to bleed or bruise easily
- Petechiae – tiny red spots on the skin
- Excessive sweating, especially at night (nocturnal hyperhidrosis)
Types of Leukemia
Based on Progression:
- Acute leukemia – this condition occurs when the young and immature white blood cells called blasts rapidly multiply and are unable to perform according to their normal functions. The symptoms worsen quickly, requiring the patient to commence an aggressive treatment as early as possible.
- Chronic leukemia – this condition happens when more mature blood cells either slowly replicate or accumulate. It may involve either an increased or decreased production of these abnormal blood cells. They may also be able to function normally in the beginning, thus the symptoms may not appear until years later.
Based on the Affected White Blood Cell Type:
- Lymphocytic leukemia – this condition involves the lymphocytes, which are the immune cells formed in the lymphatic tissue.
- Acute lymphocytic leukemia (ALL) – common in children, but can also be found in some adults
- Chronic lymphocytic leukemia (CLL) – common in adults who may be well and asymptomatic for years
2. Myelogenous leukemia – this condition affects the myeloid cells, which are the precursors of leukocytes (white blood cells), erythrocytes (red blood cells), and thrombocytes (platelets)
- Acute myelogenous leukemia (AML) – occurs more commonly in adults, but can also be diagnosed in children
- Chronic myelogenous leukemia (CML) – occurs more commonly in adults who may be well and asymptomatic for years but will experience a rapid growth and replication of leukemia cells
There are several rare types of leukemia which include:
- Hairy cell leukemia – slow progressive cancer that involves the excessive production of B cells / B lymphocytes
- Myelodysplastic syndromes (MDS) – a group of leukemia disorders wherein the blood-forming cells produced in the bone marrow undergo dysplastic change accompanied by ineffective hematopoiesis (the process of forming blood cellular components)
- Myeloproliferative disorders (MPD) – a group of leukemia disorders which involve the abnormal growth or proliferation of the blood cells in the bone marrow accompanied by effective hematopoiesis
Causes and Risk Factors of Leukemia
Currently, the exact cause of leukemia is unknown. As with other types of cancer, leukemia is believed to develop from various factors in both of a person’s genetic makeup and his or her environment.
The combination of these factors cause changes called mutations in the genetic material (DNA) of the blood cells, causing them to grow and divide immaturely and rapidly.
These abnormal blood cells crown the bone marrow, which lead to the decreased production of healthy blood cells.
The risk factors for leukemia include:
- Family history of leukemia
- Previous cancer treatment such as chemotherapy or radiotherapy
- Genetic disorders such as Down syndrome
- Chemical exposure – this may include chemicals like benzene in gasoline
Complications of Leukemia
Leukemia may cause several complications, which may include:
- Recurrent infections due to low levels of immunity
- Unintentional weight loss
- Bleeding problems
- Metabolic abnormalities – may lead to organ failure, particularly in the kidneys
- Central nervous system impairment
- Increased risk of other types of cancer
- Mental health problems
- Poor quality of life
Diagnosis of Leukemia
- History taking – to check for family history of leukemia and cancers, smoking history, and other risk factors
- Physical exam – to assess the body for the clinical manifestations of leukemia, especially swollen lymph nodes, enlargement of liver and spleen, and presence of fever and chills
- Blood tests – include complete and differential blood counts
- Bone marrow biopsy – to look for leukemia cells by means of taking a sample of bone marrow from the patient’s hipbone using a long, thin needle; also called bone marrow aspiration
- Lumbar puncture – to check for the presence of leukemia cells in the cerebrospinal fluid if the bone marrow biopsy is positive for leukemia; also called spinal tap
Treatment for Leukemia
- Medications. Several pharmacologic therapies have been used to treat leukemia such as:
- Chemotherapy – uses drugs to kill cancer cells. The most common chemotherapy protocols for leukemia may include combinations of anti-tumor antibiotics, vinca alkaloids, and other systemic anti-cancer therapy (SACT) medications.
- Targeted Therapy – uses drugs that attack specific abnormalities in the cancer cell
- Immunotherapy – utilizes the immune system to attack the leukemia cells; examples include immune system modulators and checkpoint inhibitors
2. Radiotherapy. Radiotherapy uses radiation or high-powered energy beams such as protons and X-rays to kill the cancer cells. This can last from 3 days to 6 weeks.
- External beam radiation – aims the energy beams at the affected body area
- Brachytherapy – places radioactive material inside the body in order to perform radiation therapy
3. Chimeric antigen receptor (CAR)-T Cell Therapy. This is a specialized treatment which involves the harvesting of the patient’s T-cells, engineering them to fight the leukemia cells, and infusing them back to the patient’s body.
4. Bone Marrow Transplant. BMT is a procedure wherein the unhealthy bone marrow of the leukemia patient is removed and replaced by healthy stem cells which will cause a regeneration of healthy bone marrow to produce normal blood cells. It is also known as stem cell transplant.
Nursing Diagnosis for Leukemia
Nursing Care Plan for Leukemia 1
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of leukemia as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of leukemia and its management.
|Nursing Interventions for Leukemia||Rationales|
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits).||To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning.|
|Explain what leukemia is and its symptoms, as well as the specific type of leukemia that the patient has. Inform the patient about the diagnostic tests required. Avoid using medical jargons and explain in layman’s terms.||To provide information on leukemia and its pathophysiology in the simplest way possible.|
|Educate the patient about his/her leukemia treatment plan. If the patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for bone marrow transplant, explain the procedure to the patient.||To give the patient enough information on the treatment plan, so that he/she can provide or deny an informed consent.|
|Inform the patient about the details of the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics and bowel medications. Explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of leukemia. Teach the patient on how to modify these risk factors (e.g., smoking, excessive alcohol intake, unhealthy food choices, sedentary lifestyle, etc).||To assist the patient in identifying and managing modifiable risk factors related to leukemia.|
|Inform the patient about acute oncology/hematology service of the hospital. Educate him/her about regular temperature checks while at home. Inform him/her and the carer about the signs of fever or infection, bleeding, and other serious hematologic emergencies. Provide the appropriate number to contact.||To equip the patient and his/her caregiver with proper information on what to do when new or worsening symptoms arise.|
Nursing Care Plan for Leukemia 2
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to cancer disease process and/or consequences of chemotherapy for leukemia, as evidenced by abdominal cramping, stomach pain, diarrhea or constipation, bloating, unintentional weight loss, nausea and vomiting, and loss of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Nursing Interventions for Leukemia||Rationale|
|Explore the patient’s daily nutritional intake and food habits (e.g., meal times, duration of each meal session, snacking, etc.)||To create a baseline of the patient’s nutritional status and preferences.|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake and alcohol and coffee intake.||To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement.|
|Refer the patient to the hematology/oncology dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed leukemia.|
|Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed for constipation. On the other hand, provide advice on taking anti-diarrheal medications for diarrhea.||To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe constipation/diarrhea.|
Nursing Care Plan for Leukemia 3
Nursing Diagnosis: Fatigue related to consequence of chemotherapy for leukemia (e.g., immunosuppression and malnutrition) and/or emotional distress due to the diagnosis, as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The patient will establish adequate energy levels and will demonstrate active participation in necessary and desired activities.
|Nursing Interventions for Leukemia||Rationales|
|Ask the patient to rate fatigue level (mild, moderate, or severe fatigue). Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.|
|For patients with grade 3 fatigue (severe fatigue), consider discussing having a treatment break with the oncology team.||Anti-cancer therapies such as chemotherapy treatments may increase the fatigue levels in a cancer patient, disabling them to perform even the most basic daily activities such as eating and bathing. Having a treatment break may be needed to allow the patient to recuperate before receiving further doses.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.||To gradually increase the patient’s tolerance to physical activity.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
More Leukemia Nursing Diagnosis
- Anticipatory Grieving
- Fear/ Anxiety
- Risk for Bleeding
- Risk for Infection
- Risk for Impaired Skin Integrity
- Risk for Disturbed Body Image
- Risk for Altered Oral Mucous Membranes
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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