nurse's notes

ACUTE LEUKEMIA -

• occur at any age but most frquently in children and young adult
• onset is sudden manifested by tonsilitis , furunculosis or the appearance of abscess in the mouth or skin
• high fever after few weeks
• hemorrhagic feature appear as bleeding from the gums, the nose, the stomach and rectum
• hemorrhages (bleeding) into the skin and into the fundus of the eyes
• swelling and gangrenous ulceration of the gums, the checks, the jaw and the tonsils
• bone pain
• enlargement of lymph nodes, liver or spleen

.
NURSING INTERVENTION:
1.Prevent Infection-

• have knowledge to common types of infection associated with leukemia such as pneumonia, pharyngitis, esophagitis, peri anal cellulitis, urinary tract infection, sinusitis
• monitor temperature and aware of febrile symptoms like chills, warm to touch, redness , flushed appearance
• avoid mucosal or epithelial damage by avoiding venipuncture, subcutaneous and intramuscular injection unless absolutely necessary
• maintain normal bowel function and avoiding diarrhea or constipation that possibly irritate the mucosa
• avoid foods increase bacterial colonization of gastrointestinal tract like fresh fruits and vegetables, rare meat buttermilk
• keep perianal area always clean
• prevent cross contamination by proper handwashing before and after patient contact
• avoid close contact with visitors or relatives unnecessarily
• employ meticulous personal hygiene measures by bath daily and oral care

2Preventing and managing bleeding episodes

• monitor platelet daily
• observe and be alert on minor bleeding-petechiae, ecchymoses, conjunctival hemorrhage, epistaxis, bleeding gums, heme-emesis and stools, heme positive urine, bleeding at puncture sites, vaginal spotting
• observe and be alert on serious bleeding- headache, change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension with tachycardia and dizzeness
• teach patient to remain during active bleeding episodes
• control bleeding-keep injection to a minimum

3Monitoring for toxic manifestations of chemotheraphy

• take vital signs and record and inform the doctor for any abnormal result
• make blood examination results
• weight of the patient
• watch for local irritation in the veins
• watch for any nausea and vomitting
• mouth ulcers
• expect the patient to experience hair loss during anti leukemic treatment
• assess for constipation and abdominal pain
• check deep tendon reflexes
• check for other drug side effects
• encourage patient to endure discomfort associated with the treatment
• promote oral comfort and healing

4. Control pain and discomfort
5. Promotes of coping mechanisms to deal with physiologic and emotional distress
6. Encourage participation in support group to help to diffuse anger and defendency