Nursing Diagnosis

Acute Lymphoblastic Leukemia (ALL):

Nursing Diagnosis 

Today, I will be discussing nursing diagnoses!  Nursing diagnosis is the “nurse’s clinical judgment about the patients to actual or potential heath conditions or needs.”  Unlike a medical diagnosis, a nursing diagnosis provides more in-depth information specific to the patient.  Although there are many different nursing diagnosis for ALL I will highlight five important ones:

1. Risk for Infection: ALL patients often have very low WBC count placing them at risk for infections.  Additionally, with a lot of invasive procedures a patient is at an increased risk for getting an infection.
2. Risk for Dehydration: treatments for ALL like chemotherapy has side effects like nausea and vomiting.  These side effects can prevent patients from wanting to eat/drink or they may lose fluids through vomiting and/or diarrhea.
3. Acute Pain: ALL can cause a lot of body aches and bone pain.  Additionally, the different treatment and procedures can result in acute pain.
4. Risk for Fatigue: An altered immune system can cause the patient to be extremely tired.  Treatment and procedures also take a toll of the body draining it of energy.  Lastly, the chronic stress of managing cancer places a large strain on the body.
5. Risk for Developmental Delay: If a child is diagnosed with ALL at a young age they may spend a large amount of their time in health care facilities.  This lack of a normal childhood can cause developmental delays or a regression in development.  Working with the hospital staff to establish a regular routine is crucial for child development. 

I have chosen to explore the nursing diagnosis of risk for infection.  Below I have put together a table that explores the nursing diagnosis and its many components.

Actual/Potential Manifestation	·      Low WBC ·      Immunosuppressed ·      Fever ·      Flushed skin ·      Altered mental status ·      Abnormal vital signs
Related to	·      Alteration in mature WBC ·      Bone marrow suppression ·      Invasive procedures ·      Malnutrition
Nursing Interventions	·      Place in private room ·      Proper hand washing technique ·      Closely monitor temperature ·      Monitor breath and heart sounds ·      Closely monitor catheters ·      Limit invasive procedures ·      Closely monitor CBC
Plan/Outcome	·      Lifestyle changes to promote safe environment ·      Plan in place for if fever occurs ·      Identify actions to prevent/reduce risk for infection

Works Cited:

5 Leukemia Nursing Care Plans - Nurseslabs. (2014, February 27). Retrieved April 17, 2015, from http://nurseslabs.com/5-leukemia-nursing-care-plans/

Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®). (2015, March 15). Retrieved March 21, 2015, fromhttp://www.cancer.gov/cancertopics/pdq/treatment/childALL/Patient/page1

Herdman. (n.d.). What is Nursing Diagnosis And Why Should I Care? Retrieved February 22, 2015, fromhttp://www.nanda.org/What-is-Nursing-Diagnosis-And-Why-Should-I-Care_b_2.html

Nursing Care

Acute Lymphoblastic Leukemia (ALL):

Nursing Care

Today, I will be talking about the nursing care involved with ALL.  This care can vary greatly depending on the stage of cancer, whether the patient is in the hospital or at home, and the age of the patient.  I will start with the basic care considerations the nurse will go through.

Fever: Because the body is compromised it may have a hard time fighting infection.  This decreased immunity places the patient at an increased risk for infection and is often displayed through a fever.  Monitoring if an ALL patient has a fever can save their life.  Even a slight increase in fever needs to be quickly noted to start infection management.  Additionally, it is important to stay away from medications like tylenol that may mask fevers.  Your health care team wants to know immediately if a fever occurs! 

Bleeding: With an increased amount of immature lymphocytes there are not as many platelet cells that are responsible for clotting the blood.  A low platelet count places the patient at an increased risk for bleeds.  The nurse is aware of this risk and will closely monitor the patient for any signs of internal or external bleeds. 

Bone Pain: Bone pain is a common side effect of ALL.  This pain can be severe and very uncomfortable.  Addressing and managing this pain is a primary concern.  Many times alternatives to medication can be used like the use of hot/cold packs, listening to calming music, or acupuncture.  Additionally, medication can be used to help with comfort.  There are many different pain management plans that could be used.  Ask your nurse about these many options, don't feel you need to settle on one plan!

Diet: The treatments for ALL like chemotherapy can be very wearing on the body resulting in extreme fatigue.  Maintaining a well balanced diet is essential for recovery and keeping the body strong to withstand treatment.

Nausea/Vomiting: A dreaded side effect of chemotherapy is nausea/vomiting.  This side effect can be very intense and again make the patient lose a lot of strength.  Anti-nausea medications can be given to help with this side effect.

Positive Attitude: The nurse needs to stay positive for the patient.  Receiving a cancer diagnosis can be extremely overwhelming and can be hard to accept.  Remaining positive and supportive is essential for the patient.

Works Cited:

Acute Lymphocytic Leukemia In Children. (n.d.). Retrieved April 14, 2015, from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Acute-Lymphocytic-Leukemia-In-Children.aspx

Caregiving for a Loved One With Leukemia. (n.d.). Retrieved April 14, 2015, from http://www.everydayhealth.com/leukemia/caregiving-for-leukemia.aspx

Integrative Cancer Care: Communication is Key - Desert Health®. (n.d.). Retrieved April 14, 2015, from http://deserthealthnews.com/stories/integrative-cancer-care-communication-is-key/

Treatment

Acute Lymphoblastic Leukemia (ALL):

Treatments

Today, I will be discussing the different treatment options for fighting ALL.  When deciding what treatment to follow for ALL a number of factors need to be taken into account.  The appearance of the lymphocytes, the subtype, whether the patient has had cancer treatment in the past, whether ALL is left the bone marrow, presence of systemic infection, and the patients age and general health.

Cancer treatment has come so far today!  We are so lucky that there are now choices and different ways to fight this horrible childhood illness.  Lets explore these treatment options below:

Chemotherapy- a toxic drug is administered to the body that works by killing the cancer cells, but it also affects many of the health cells.  A central line is placed surgically in a vein in the upper chest.  This line works as a port where medication and chemo can be administered and blood tests can be drawn from.  This port makes it so the patient does not need to be constantly stuck with needles.  The goal of induction is remission meaning eliminating leukoblastic cells from the body.  Many times remission is not achieved after one round of treatment and additional rounds are required.

Central Nervous System (CNS) Prophylaxis- cancer cells often collect in the spinal cord and brain.  It this is not treated relapse will likely occur.  A drug is injected directly into the spinal column and other hard places the chemotherapy cannot reach.

Stem Cell Transplantation- Many patients need more than chemotherapy and will follow this treatment with a stem cell transplant.  It can be challenging to find a perfect match; many times it is a family member that meets the criteria.  A stem cell transplant can be dangerous for the patient.  In order to accept the transplant the patient’s immunsystem needs to be wiped out so the body does not reject the new stem cells entering the body.  However, when the transplant is a success the results can be amazing!

With all of these treatments the patient immune system needs to be closely protected.  All of these treatments greatly weaken the immune system, exposure to the simplest cold can be fatal to the patient.  These are some of the most common treatments.  However, science is constantly changing and improving!  We should all be excited about what cancer treatment looks like in the future!

Works Cited:

Acute Lymphoblastic Leukemia. (n.d.). Retrieved April 12, 2015, from http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/leukemia

Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®). (2015, March 15). Retrieved March 21, 2015, from http://www.cancer.gov/cancertopics/pdq/treatment/childALL/Patient/page1

Pediatric Acute Lymphoblastic Leukemia . (n.d.). Retrieved March 21, 2015, from http://emedicine.medscape.com/article/990113-overview