{ "name": "Leukemia", "slug": "leukemia", "url": "https://nursingplex.com/care-plans/leukemia", "category": "Hematologic & Lymphatic", "summary": "Malignant white cell proliferation; neutropenic precautions, bleeding risk and chemo support.", "nursing_diagnoses": [ "Risk for infection", "Risk for bleeding", "Fatigue", "Imbalanced nutrition" ], "overview": [ "Leukemia is a malignant proliferation of immature white cells in the bone marrow. The abnormal blasts crowd out normal hematopoiesis, so the patient ends up with too many useless white cells and too few of everything that matters: neutrophils to fight infection, red cells to carry oxygen and platelets to clot. Almost every nursing problem in leukemia traces back to that single fact.", "Acute leukemias (ALL, AML) appear abruptly with fever, fatigue, bruising and bone pain and require immediate induction chemotherapy. Chronic leukemias (CLL, CML) often surface on a routine blood count in an older adult and progress over years. ALL is the most common childhood cancer and has excellent cure rates; AML predominates in adults.", "Treatment moves through induction, consolidation and maintenance, sometimes with stem cell transplantation. Nursing care during those phases is dominated by neutropenic precautions, transfusion support, mucositis and nausea management, tumor lysis prevention, and long conversations with families about a treatment course measured in months and years." ], "key_facts": [ { "label": "Core deficit", "text": "Marrow replacement causes neutropenia (infection), anemia (fatigue) and thrombocytopenia (bleeding) at once." }, { "label": "Infection risk", "text": "Absolute neutrophil count below 500 is severe neutropenia; a single temperature of 38 °C is an emergency." }, { "label": "Fever rule", "text": "Neutropenic fever means cultures then broad-spectrum antibiotics within one hour — do not wait for results." }, { "label": "Tumor lysis syndrome", "text": "High potassium, phosphate and uric acid with low calcium after induction; prevent with hydration and allopurinol/rasburicase." }, { "label": "No masking", "text": "Avoid antipyretics without an order — they hide the only warning sign a neutropenic patient may show." } ], "nursing_priorities": [ "Prevent and rapidly treat infection in a neutropenic host.", "Prevent and manage bleeding from thrombocytopenia.", "Manage anemia-related fatigue and activity intolerance.", "Prevent tumor lysis syndrome during induction.", "Control nausea, mucositis and maintain nutrition.", "Protect central line integrity and prevent line infection.", "Support the patient and family through prolonged, high-stakes treatment." ], "assessment": { "subjective": [ "Profound fatigue and breathlessness on minimal exertion", "Bone and joint pain, especially in children with ALL", "Frequent or lingering infections, sore throat, mouth pain", "Night sweats, weight loss and loss of appetite", "Fear about prognosis, treatment length and financial strain" ], "objective": [ "Pallor, tachycardia, low hemoglobin and hematocrit", "Petechiae, purpura, gum bleeding, epistaxis and prolonged oozing", "Fever, which may be the only infection sign when neutrophils are absent", "Very high, very low or normal white count with circulating blasts on smear", "Lymphadenopathy, hepatosplenomegaly and sternal tenderness", "Oral ulceration, thrush and perianal fissures", "Rising potassium, phosphate, uric acid and creatinine with falling calcium after chemotherapy" ], "related_factors": [ "Marrow replacement by leukemic blasts", "Myelosuppression from chemotherapy and radiation", "Mucosal barrier breakdown from cytotoxic therapy", "Indwelling central venous access", "Massive cell lysis after the first chemotherapy doses", "Hypermetabolic state with poor intake" ] }, "goals": [ "The client will remain free of infection, or infection will be identified and treated within one hour of fever.", "The client will show no active bleeding and maintain a platelet count above the transfusion threshold.", "The client will tolerate progressive activity with a stable heart rate and no dizziness.", "The client will maintain normal potassium, phosphate, calcium and renal function through induction.", "The client will maintain weight within 5% of baseline and intact oral mucosa or controlled mucositis pain.", "The client and family will describe neutropenic precautions and when to call before discharge." ], "interventions": [ { "title": "1. Preventing and detecting infection", "points": [ "Perform meticulous hand hygiene and enforce it for every visitor; it remains the single most effective intervention.", "Monitor temperature every 4 hours and report any single reading of 38 °C or above immediately, even if the patient looks well.", "Track the absolute neutrophil count daily and adjust precautions accordingly.", "Inspect the mouth, perianal area, skin folds and every line site each shift — these are the usual portals.", "Avoid rectal temperatures, suppositories, enemas and urinary catheters whenever possible.", "Restrict fresh flowers, standing water and visitors with any illness; teach dietary precautions per institutional protocol.", "Draw blood and urine cultures and give the first broad-spectrum antibiotic dose within one hour of a neutropenic fever.", "Administer growth factors such as filgrastim as ordered and teach the expected bone pain." ] }, { "title": "2. Preventing bleeding", "points": [ "Monitor platelet counts and assess daily for petechiae, bruising, gum bleeding, hematuria and melena.", "Use a soft toothbrush or swabs, an electric razor, and avoid flossing when platelets are low.", "Avoid intramuscular injections and hold pressure at least 5 minutes after any venipuncture.", "Prohibit aspirin and NSAIDs; check every new medication.", "Transfuse platelets per protocol and monitor for reactions and post-transfusion count response.", "Assess neurologic status for intracranial bleeding: new headache, confusion, visual change or unequal pupils." ] }, { "title": "3. Managing anemia and fatigue", "points": [ "Assess hemoglobin trends alongside symptoms rather than transfusing on a number alone.", "Cluster care and build scheduled rest periods around therapies and meals.", "Assist with activity, monitor for orthostatic changes, and teach energy conservation.", "Transfuse packed red cells per order with correct identification and reaction monitoring.", "Give supplemental oxygen for symptomatic hypoxia." ] }, { "title": "4. Preventing tumor lysis syndrome", "points": [ "Give aggressive IV hydration before and during induction as ordered.", "Administer allopurinol or rasburicase per protocol to control uric acid.", "Monitor potassium, phosphate, calcium, uric acid and creatinine at ordered intervals — often every 6–8 hours initially.", "Watch for muscle cramps, tetany, arrhythmias and decreased urine output and report immediately.", "Maintain strict intake and output and report output below 0.5 mL/kg/hr." ] }, { "title": "5. Nutrition, mucositis and nausea", "points": [ "Provide oral care with a soft brush and a bland rinse (saline or sodium bicarbonate) four times daily; avoid alcohol-based mouthwash.", "Assess the mouth daily using a consistent mucositis scale and treat pain before meals.", "Give scheduled antiemetics before chemotherapy and around the clock during peak emetogenic periods.", "Offer soft, cool, bland, high-protein foods in small portions; avoid acidic, spicy, rough or very hot items.", "Weigh daily, track intake, and involve dietetics early; use enteral or parenteral support when intake fails." ] }, { "title": "6. Central line and chemotherapy safety", "points": [ "Use strict aseptic technique with a scrub-the-hub routine for every line access, and change dressings on schedule.", "Assess the site for redness, tenderness, drainage and swelling every shift.", "Verify blood return before administering vesicant chemotherapy and know the extravasation protocol.", "Follow safe-handling precautions for cytotoxic drugs and body fluids for the required period after administration." ] }, { "title": "7. Psychosocial and developmental support", "points": [ "Give honest, staged information; families absorb little at diagnosis and need repetition.", "For children, maintain school, play and routine as much as isolation allows and involve child life services.", "Screen for depression, anxiety and financial distress and refer to social work.", "Discuss fertility preservation before treatment starts where relevant.", "Connect patients with survivorship programs and peer support." ] } ], "patient_teaching": [ "Take your temperature whenever you feel unwell and call immediately for 38 °C or above — do not take fever medicine first.", "Wash hands often, avoid crowds and sick contacts, and follow the food safety rules you were given.", "Report bleeding, bruising, black stools, blood in urine, or a headache that will not go away.", "Use a soft toothbrush and electric razor; avoid aspirin and ibuprofen.", "Keep hydrated and attend every lab appointment — counts guide the whole treatment plan.", "Care for your central line exactly as taught and report redness, pain, fever or leaking.", "Ask about vaccination timing for you and your household; live vaccines are usually avoided." ] }