Case Pres PPT

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Laboratory and

Diagnostic Procedures

Result Normal Values Interpretation

CBC

White Blood Cells(WBC)

Lymphocytes

Red Blood Cells

(RBC)

0.6

0.58

2.21

Adults: 5-10x109/L

Children: 6.2-

17.0x109/L

0.20-0.40

Male: 4.5-

6.0x109/L

Female: 4.0-

5.5x109/L

Lymphoblast’s quickly grows andreplace WBC in the bone marrow and

prevent from being made.

The bone marrow produces immaturecells that develop into leukemic white

blood cells called lymphoblasts. These

abnormal cells are unable to function

properly, and they can build up and

crowd out healthy cells.

Due to increased production of

Lymphocytes it results in decreased

production of RBC and resulting into

anemia which is one of the primary

symptoms of ALL.



Laboratory and



Hemoglobin

Hematocrit

Segmenters

Monocytes

APC

Platelet count

61

0.19

0.25

0.07

28

Male: 120-170g/L

Female: 110-

150g/L

Male: 0.40-0.54

Female: 0.37-0.47

0.50-0.70

0-0.07

150-450x109/L

Changes in this level are due to changes

in the Red Blood Cell count and occur for

the same reason resulting to decrease

tissue perfusion and leading to pale skin.

Decreased in Hematocrit count is due to

decreased Red Blood Cell and resulting

into anemia.

Decreased in Segmenters is usually due

to decreased WBC count and occur for

the same reason.

Not remarkable

Because of decreased production of

Platelet, frequent bleeding results as

manifested by bruises.



Laboratory and



ALT (SGPT)

AST (SGOT)

22.0

24.3

7 -56

5-40

There is no remarkable result in bothALT (SGPT) and AST (SGOT). Results

are both in normal range which

implies that there is no excessive

released in Aspartate

Aminotransferase (found in heart,

kidney, brain, muscle and liver) and

Alanine Aminotransferase (largely

found in liver). Liver detoxify

medicine normally (as the patient is in

still in chemotherapy).



Other Laboratory and Diagnostic

Procedures for ALL

Bone marrow test

• Doctors will classify blood cells in to thespecific types based on their size, shape and

other features• Look for certain changes in the cancer cells

and determine whether the leukemia cells

began from B lymphocytes or T lymphocytes.• This information helps the doctor develop a

treatment plan.



X-rays

• Routine chest x-rays may be done if the doctor

suspects a lung infection. They may also bedone to look for enlarged lymph nodes in thechest.

Computed tomography (CT) scan• This test can help tell if any lymph nodes or

organs in your body are enlarged. It isn'tusually needed to diagnose ALL, but it may be

done if your doctor suspects leukemia cellsare growing in an organ, like your spleen.



Magnetic resonance imaging (MRI) scan

• Like CT scans, MRI scans provide detailed images

of soft tissues in the body.• MRI scans are very helpful in looking at the brain

and spinal cord.

Ultrasound• Ultrasound uses sound waves and their echoes to

produce a picture of internal organs or masses.

•

Ultrasound can be used to look at lymph nodesnear the surface of the body or to look for

enlarged organs inside your abdomen such as the

kidneys, liver, and spleen.



TREATMENT

In general, treatment for ALL falls into separate phases:

Induction therapy

•To kill most of the leukemia cells in the blood and bonemarrow.

Consolidation therapy

• Also called post-remission therapyDestroying the leukemia cells remaining in the brain orspinal cord.



Maintenance therapy

• Prevents the leukemia cells from regrowing.

The treatments used in this stage are oftengiven at much lower doses.

Preventive treatment to the spinal cord

• Chemotherapy drugs are injected directly into

the fluid that covers the spinal cord.

• This kills cancer cells that can’t be reached by

chemotherapy drugs given by mouth or

through all intravenous line.



Treatments may include:

Chemotherapy

• It uses drugs to kill cancer cells

• Typically used as an induction therapy for

children and adults with ALL.

• This can also be used in the consolidation and

maintenance therapy.

Targeted drug therapy

• Attack specific abnormalities present in the

cancer cells that may help them grow and

thrive.



Radiation therapy

• Uses high-powered beams.

This is used if the cancer cells have spread to thecentral nervous system.

Stem cell transplant• Used as a consolidation therapy in people at high-

risk of relapse or for treating when it occurs.

•

This procedure allows someone with leukemia tore-establish healthy stem cells by replacing

leukemic bone marrow with leukemia-free flow.



Generic

Name

Dosage/

frequency

and

Route of admin

Action Indicatio

n

Contra-

indicatio

n

Adverse

Reaction

Nursing

Management/Cons

ideration

CEFTAZIDI

ME

375 mg

every 8

hours

intraveno-usly

Slow IV

Third

generation

cephalospo

rin thatinhibits

cell-wall

synthesis,

promoting

osmoticinstability

usually

bactericidal

Serious

UTI and

lower

respiratory tract

infection

Patients

hypersen

sitive to

drug orother

cephalos

porin

Headache,

dizziness

,paresthesia

,seizures,phlebitis,

rashes,

urticaria

>before

administration, ask

patient if he is

allergic to penicillinor cephalloporins

>obtain specimen

for culture and

sensitivity tests

before giving firstdose

>therapy may

begin while

awaiting results



Generic

Name

Dosage/fre

quency and

Route of

admin

Action Indication Contra-

indication

Adverse

Reaction

Nursing

Management/C

onsideration

AMIKACIN

SULFATE

55mg every

8 hoursintravenous

ly(negative)

ANST

Inhibits

proteinsynthesis by

binding

directly to

the 3OS

ribosomal

subunit;bactericidal

erious

complicatedand recurrent

urinary tract

infections due

to these

organisms.

Contraindic

ated inpatientshyp

ersensitive

to drug or

other

aminoglyco

sides

Neuromusc

ularblockade

ototoxicity,a

zotemia,nep

hrotoxicity,i

ncrease in

urinaryexcretion of

casts

>obtain

specimen forculture and

sensitivity test

befoe giving first

dose,therapy

may begin

waiting results>evaluate

patients hearing

before and

dering therapy.if

he will bw

receiving drugfor longer than 2

weeks

>notify

prescriber if

patient has

tinnitus or

hearing loss



Generic

Name

Dosage/fr

equency

and

Route of

admin


indicatio

n

Adverse

Reaction

Nursing

Management/Cons

ideration

ACICLOVI

R

SODIUM

400mg/5

ml/5ml

every 6

hours per

orem

Interfere

s with

DNA

synthesis

and

inhibitsviral

multiplic

ation

First and

recurrent

episodes of

mucotaneous

herpes simplex

virus(HSV-1and HSV-2)

infections in

immmunocom

promized

patients

.severe firstepisode of

genitals herpes

in patients

who went

immunocompr

omized

Contrain

dicated

in

patients

hyperse

nsitivityto drug

Malaise,head

eche,enceph

alophatic

changes,naus

ea,vomiting,

diarrhea,hematuria,acut

e renal

failure,rash,it

ching.urticari

a,inflamation

or phlebitiisto injection

site

>dont give IM or

subcutaneously

>in patiennts with

renal disease on

dehydration and in

those taking othernephrotoxic

drug,monitor rena

function



Generic Name Dosage/

frequen

cy and

Route of

admin

Action Indicati

on

Contra-

indication

Adverse

Reaction

Nursing

Management/Consi

deration

RANITIDINE

HYDROCHLORI

DE

8mg

every

hours

intraven

ously

Slow IV

Competiti

ve

inhibits

action of

histamine

on theH2at

receptor

sites of

parietal

cells,decr

easinggastric

acid

secretion

* Treat

ment of

GERD.

Sympto

matic

relief commo

nly

occurs

within

24

hoursafter

starting

therapy

with

ranitidi

ne

Contraind

icated in

patients

hypersens

itive to

drug andthose

with

acute

porphyria

Vertigo,malais

e,headache,bl

urred

vision,jaundic

e ,burning and

itching oninjection

site,anaphylax

is,angioedema

Assess patient for

abdominal

painnote presence

of blood in

emesis,stool or

gastric aspirate>drug may be

added to total

parenteral nutrition



Generic Name Dosage/f

requency

and

Route of

admin

Action Indicatio

n

Contra-

indication

Adverse

Reaction

Nursing

Management/Co

nsideration

CYTARABINE 35 mg IV It kills

cancer

cells by

interferin

g withDNA

synthesis

Acute

non

lymphocy

tic

leukemia,acute

lymphocy

tic

leukemia

Contraindi

cated in

patients

hypersens

itive tothe drug

Neurotoxicity,

malaise,dizzine

ss

Headache,cere

bellarsyndrome,ede

ma,conjuctiviti

s,nausea,vomit

ing,diarrhea,ur

ine

retention,renaldysfunction,ra

sh pruritus

alopecia,

freckling

>for intrathecal

administration,us

e preservative-

free normal

saline solutionadd 5ml to

100mg vial or

10ml to 500 mg

vial.use

immediately

afterreconstitution.Di

scard unused

drug.



Generic Name Dosage/f

requency

and

Route of

admin


indication

Adverse

Reaction

Nursing

Management/Consid

eration

PARACETAMOL 110mgevery

4hours

intraveno

uly prn

for temp

of 38

Unknownthought to

produce anlgesia

by bloking pain

impulses by

inhibiting

synthesis of prostaglandin in

the CNS or other

substances that

sensitize pain

receptors

>drug mayreieve fever

through central

action in the

hypothalamic

heat-regulating

center

Pre BTmeds:

mild pain

or fever

Contraindicated in

patients

hypersensi

tive to the

drug

Hematologic,hemoly

ticanemia,

neutropen

ia,leukope

nia

jaundicerashes,urti

caria

>many OTC andprescription products

contain aceta

minophen;be aware

of this when

calculating total daily

dose>use liquid form for

children and patients

who have difficulty of

swallowing.



Generic Name Dosage

/freque

ncy and

Route

of

admin


indication

Adverse

Reaction

Nursing

Managemen

t/Considerat

ion

METOCLOPRA

MIDE

HYDROCHLORI

DE

1.8 mg

intraven

ously

Blocks

dopamin

e

receptor

s at

chemore

ceptortriggerzo

ne

To prevent

or reduce

nausea

and

vomiting

from

emetogenic cancer

chemother

apy

Contraindic

ated in

patients

hypersensi

tive to the

drug and in

those withpheochrom

ocytoma or

seizure

disorders

Contrain

dicated

in

patients

hypersen

sitive to

the drug

>monitor

bowel souds

>safety and

effectiveness

of drug

haven’t been

establishedfor therapy

lasting

longer than

12 weeks



Generic

Name

Dosage/fr

equency

and

Route of

admin


indicatio

n

Adverse

Reaction

Nursing

Management/

Consideration

DIPHENHYDR

AMINE

HYDROCHLO

RIDE

110mg IV Comple

tes

with

histami

ne for

H,-

recepto

r sites

Pre

BT med:rh

initis,allerg

y

symptoms,

motion

sickness,pa

rkinsons

disease

Contrain

dicated

in

patients

hyperse

nsitive

to the

drug

CV and

CNS

effects.Bl

ood

disorders.

Allergic

reactions

>stop drug 4

days before

diagnostic skin

testing

>Alternative

injection sites

to prevent

irritation.

>give IMinjection deep

into large

muscle



Generic

Name

Dosage/

frequenc

y and

Route of

admi

Action Indica

tion

Contra-

indication

Adverse

Reaction

Nursing

Management/C

onsideration

FUROSE

MIDE

10mg IV acts by

inhibit

ing

NKCC2

Post

BT m

eds:

Acute

pulmo

nary

edem

a

>Contraindicat

ed in patients

hypersensitive

to the drug

and in those

with anuria

Allergic

reaction,hy

peruricemia

;bone

marrow

depression

>to prevent

nocturia,give P.O

and I.M

preparations in

the

morning.Give

second dose in

early afternoon

Generic Dosage/ Action Indication Contra-indication Adverse Nursing



Generic

Name

Dosage/

frequency and

Route of admi

Action Indication Contra indication Adverse

Reaction

Nursing

Management/Considerati

on

TRANEXA

MIC ACID

110 MG IV Tranexamic acid

is a synthetic

derivative of the

amino acid

lysine. It exerts

its

antifibrinolytic

effect through

the reversible

blockade of

lysine-binding

sites on

plasminogen

molecules.

Tranexam

ic acid is

used for

the

prompt

and

effective

control of

hemorrha

ge in

various

surgical

and

clinical

areas:

Ex.patient

is on

active(mo

uth

sore)blee

ding

*

1. Allergic

reaction to

the drug or

hypersensitivi

ty

2. Presence of

blood clots

(eg, in the leg,

lung, eye,

brain), have a

history of blood clots,

or are at risk

for blood

clots

3. Current

administratio

n of factor IX

complex

concentrates

or anti-

inhibitor

coagulant

concentrates

Gastrointestinal

disturbances

(nausea,

vomiting,

diarrhea) may

occur but

disappear when

the dosage is

reduced.

Giddiness and

hypotension

have been

reported

occasionally.

Hypotension has

been observed

when

intravenous

injection is too

rapid.

1. Unusual change in

bleeding pattern

should be

immediately

reported to the

physician.

2. Tranexamic Acid

should be used with

extreme caution in

CHILDREN younger

than 18 years old;

safety and

effectiveness in

these children have

not been confirmed.

3. Inform the client

that he/she should

inform the physician

immediately if the

following severe side

effects occur:



Assessment Diagnosis Rationale Planning Nursing

intervention

Rationale Evaluation

SUBJECTIVE:

“ napansin

kong

nagdurugo

yung labi atgilagid nya” as

verbalized by

the mother.

OBJECTIVE:

Bleeding in

gums and lips

Headache and

dizziness

Blurring of

vision

T: 35.3

P: 103R: 24

BP: 90/40

RBC: 21.2

Hct: 0.28

Platelet: 28

Risk for

bleeding

related to

decreased

plateletcount

Decreased in

the platelet

resulting to

dehydration

anddecreasing

the clotting

factor.

After 8 hours of

Nursing

Intervention,

Jomach will be

protect frominfection and

bleeding hazard

that may

contribute to

patient’s health

condition and

may

demonsstrate

improvement in

vital signs,

laboratory

result, and

lessen the

difficulty of

body function.

INDEPENDENT:

Assess vital signs

every 4 hours and

body systems

every shift forbleeding:

1.Skin and mucous

membranes for

petechiae,

ecchymoses, and

hematoma

formation

2.Encourage use of

soft-bristle

toothbrushor sponge to clean

teeth and gums to

prevent bleeding

and risk of

infection

1.Suppression

of bone

marrow and

platelet

production

places patient

at risk of

spontaneous/

uncontrolled

bleeding.

2.Fragile

tissues and

alteredClotting

mechanisms

increase the

risk of

hemmorhage

following even

minor trauma.

Goal Met:

After 8 hours

of Nursing

InterventionJomach was

protected

from infection

and bleeding

hazard that

may

contribute to

patient’s

health

condition and

the mother

demonstrate

improvement

in vital signs,

laboratoryresult, and

lessen the

difficuty of

body function.



Assessment Diagnosis Rationale Planning Nursing intervention Rationale Evaluation

3. Limit oral care to

mouthwash if

indicated (a mixture of

1 tsp baking soda or

salt in 4-8 oz water orhydrogen peroxide in

water) avoid a

mouthwash with

alcohol.

4. Provide soft diet.

COLLABORATIVE:

1. Administer IV fuids

as indicated.

3. When beeding is

present, even gentle

brushing more cause

more tissue damage.

Alcohol has a dyingeffect and may

painful to irritated

tissues.

4. May help reduce

gum irritation.

1.Maintains

fluid/electrolyte

balance in the

abscence of oral

intake; prevents orminimizes tumor

lysis syndrome,

reduces risk of renal

complications.



Assessment Diagnosis Rationale Planning Nursing intervention Rationale Evaluation

2. Administer

medications as

indicated,e.g.:

Antiemetics: 5-HT,

receptor antagonist

drugs such as

ordanseton (Zofran) or

granisetron (Kytril);

Allopurinol

(Zylopoprim)

Potassium acetate or

citrate, sodium

bicarbonate;

2. Relieves

nausea/vomiting

associated with

administration of

chemotherapy agents.

Improves renal

excretion of toxic by

products from

breakdown of leukemia cells.

Reduces the chances

of nephropthy as a

result of uric acid

production.

May be used to

alkalinize the urine,

preventing or

minimizing tumor lysis

sydney/kidney stones.



Assessmen

t

Diagnosis Rationale Planning Nursing intervention Rationale Evaluation

Stool softeners.

Administer RBCs,

plateles, clotting

factors.

Helpful in reducing

straining at stool with

trauma to rectal

tissues

Restores/normalizes

RBC count and

oxygen-carrying

capacity to correct

anemia. Used to

prevent/treat

hemmorhage.

i i i l l i i i l l i




intervention


SUBJECTIVE:

“Napansin ko

na

madalas

mgkaroon ng ng

pasa at palaging

pagod at

nanghihina si

Jomach”

as verbalized by

the

mother

OBJECTIVE:

Irritability

Pallor of skin

and mucous

membranes

V/S taken as

follows

T: 35.3

P: 103

R: 24

BP: 90/40

Risk for

infection

related

to

inadequa

te

primary

defenses

Decreased

in the

ability to

guard self

from

internal or

external

threats

such as

illness or

injury.

After 8 hours

of

nursing

interventions

the

patient will

identify

actions to

prevent or

reduce

the risk for

infection.

INDEPENDENT:

1. Require good

handwashing

protocol for all

personnel and

visitors.

2. Place the

patient in private

room. Limit

visitors as

indicated.

Prohibit use of

live plants or cut

flowers.

3. Restrict fresh

fruits and

vegetables or

make sure they

are washed or

peeled.

1. Prevents

stasis of

respiratory

secretions,

reducing risk

of atelectasis

or

pneumonia.

2. Protect

patient from

potential

sources of

pathogens or

infection.

3. Prevents

crosscontami

nation

or reduce risk

for infection.

After 8 hours

of

nursing

interventions

the

patient was

able to

identify

actions to

prevent or

reduce

the risk for

infection.

A Di i R i l Pl i N i i i R i l E l i



Assessmen

t

Diagnosi

s

Rationale Plannin

g

Nursing intervention Rationale Evaluation

COLLABORATIVE:

1. Prepare for or

assist patient with

leukemia

treatments such as

chemotherapy,

radiation, and bone

marrow

transplantation.

2. Administer

antibiotics as

indicated.

1. Leukemia is usually

treated with a

combination of these

agents, each requiring

specific safety

precautions for patient

and care providers.

2. May be given

prophylactically or

to treat specific

infection.

A t Di i R ti l Pl i N i R ti l E l ti




intervention


Subjective

Cue(s):

“Nahihirapan

po syang

huminga ” as

verbalized by

the mother

Objective

Cue(s):

-V/S:

RR: 36

PR: 84

Nausea

Pallor/palene

ss

Weakness

Easy

fatigability

Headache and

dizziness

Ineffectiv

e Tissue

Perfusion

r/t

Inadequa

tte red

bood cell

producti

on as

manifest

ed by

bradypne

a,

tachycard

ia,

Nausea

Abdomin

al pain

Pallor

Weaknes

s

Easy

fatigabilit

y

Decreased

in oxygen

resulting

in the

failure to

nourish

the

tissues at

the

capillary

level.

After 8 hours of

Nursing

Intervention,

Jomach will

demonstrate

increased tissue

perfusion as

individually

appropriate.

OBJECTIVES:

A.) To identify

causative/contri

buting factors.

B.) To assist

client to

correct/minimize

impairment and

to promote

healing.

C.) To promote

wellness.

A. To identify

causative/contrib

uting factors.

Independent:

1. Note reports of

increasing

fatigue,

weakness.

Observe for

tachycardia,

pallor of

skin/mucous

membranes,

dyspnea, and

chestpain. Plan of

patient activities

to avoid fatigue.

2. Note poor

hygiene/health

practices(e.g. lack

of cleanliness,

poor dental care.)

1.May reflect

effects of

anemia and

cardiac

responses. To

let the

patient rest.

2. May

impacting

tissue health.

Goal Met:

After 8 hours

of Nursing

Intervention,

Jomach

demonstrate

increased

tissue

perfusion as

individually

appropriate.

A. Causative

contributors

and been

identified.

A Di R ti l Pl i N i i t ti R ti l E l ti



Assess

ment

Diagn

osis

Rationale Planning Nursing intervention Rationale Evaluation

B. To assist client to

correct/minimize

impairment and to

promote healing.

1. Monitor V/S and

monitor I and O.

2. Elevate HOB(10

degrees) andmaintain

head/neck in midline or

neutral position.

3. Encourage quiet, restful

atmosphere.

4. Caution patient to

avoid activities that

increase cardiac workload

(e.g., straining at stool).

5. Provide small/ easily

digested food and fluids,

when tolerated and

encourage rest after

meals.

1. To have a baseline

data.

2. To promote

circulation/venous

drainage.

3. Conserves energy/

lowers tissue Oxygen

Demand.

4. To lessen the work of

the heart.

5. To maximize blood

flow to stomach,

enhancing digestion.

B.

Correct/Mini

mize

impairment

and to

promote

client’s

healing has

been

assisted.

Assess Diagnosis Rationale Planning Nursing intervention Rationale Evaluation



Assess

ment


Collaborative:

1. Asssess blood supply

and sensation(nerve

damage) of affected

area.

2. Evaluates

pulses/calculate ankle-

brachial index.

1. To evaluate

actual/potential for

impairment of circulation

to lower extremities.

2. Result less than 0.9

indicates need for close

monitoring/ more

agressive intervention.

C. Wellness

had been

promoted.

Assessment Diagnosis Rationale Planning Nursing Rationale Evaluation




intervention


Subjective:

“Puro pasa

yung

katawan niya

at hinang-

hina siya.” As

verbalized by

the mother.

Pain

Scale:3/5

Objective:

decreased

RR(25cpm),

decreased

CR(90bpm),

sunken

eyeballs,

pale-looking,

petechiae,

fever

(temp:38.0)

Acute pain

related to

physical

agents—

enlarged

organs and

lymph

nodes, bone

marrow

packed with

leukemic

cells,

chemical

agents—

antileukemi

c

treatments,

psychologic

al

manifestatio

ns—anxiety,

fear

Acute lymphocytic

leukemia (ALL)

occurs when the

the body produces

a large number of

immature white

blood cells, called

lymphocytes. The

cancer cells quickly

grow and replace

normal cells in the

bone marrow. Bone

marrow is the soft

tissue in the center

of bones that helps

form blood cells.

ALL prevents

healthy blood cells

from being made.

Life-threatening

symptoms can

occur.

After 24 hours

of nursing

intervention

client will be

relieved of

pain in relation

to having signs

and symptoms

of acute

lymphocytic

leukemia, will

appear relaxed

and able to

sleep and rest

appropriately,

and will

demonstrate

behaviors of

managing pain.

1.Investigat

e reports of

pain. Note

changes in

degree (use

scale of 0 to

10) and site.

2. Monitor

vital signs

and note

nonverbal

cues, such

as muscle

tension and

restlessness

.

1.Helpful

in

assessing

need for

interventi

on and

may

indicate

developin

g

complicati

ons.

2.May be

useful in

evaluating

verbal

comments

and

effectiven

ess of

interventi

ons.

After 24

hours of

nursing

intervention

client was

relieved of

pain in

relation to

having signs

and

symptoms of

acute

lymphocytic

leukemia,

appeared

relaxed and

able to sleep

and rest

appropriately

, and

demonstrate

d behaviours

of managing

pain.




Assess

ment


3. Provide quiet

environment and reduce

stressful stimuli: noise,

lighting, and constant

interruptions.

4. Place in position of

comfort, and support

joints and extremities

with pillows and other

padding.

5. Reposition periodically

and provide or assist

with gentle range-of-

motion (ROM) exercises.

3.Promotes rest and

enhances coping

abilities.

4.May decrease

associated bone and

joint discomfort.

5.Improves tissue

circulation and joint

mobility.

Assessment Diagnosis Rationale Planning Nursing Rationale Evaluation




intervention


Subjective:

“Walang

ganang

kumain ang

anak ko.” As

verbalized

by mother.

Objective:

Decreased

CR(85bpm),

Decreased

RR(20cpm),

Weight: 6lbs

Inflamed

oral mucous

membrane,

Pale-

looking,Sunken

eyeballs

Altered

Nutrition

: Less

than

Body

Requirem

ents

related

to

Loss of

Appetite

and

Weaknes

s

Imbalance

nutrition: less than

body

requirements

refers to an intake

of nutrients

insufficient to

meet daily

requirements

because of

inadequate food

intake or improper

digestion and

absorption of

food. An

inadequate food

intake may be

caused by the

inability to acquireor prepare food,

inadequate

knowledge about

essential nutrients

and a balanced

diet.

After 24

hours of

therapeutic

nursing

interventio

n, client

will

demonstrat

e good

appetite,

will

improve

nutrition

status, and

will

manifest

appropriat

e daily

activities.

1.Weigh

regularly and

evaluate

weightloss over

time.

2. Offer client

small but

frequent

mealand snacks

including low-

fat,high-caloric

food e.g.,

potatoes,

bread.

3. Give

supplemental

nutritione.g.,multivitami

ns

1.To determine

degree of

malnutrition.

2. Bigmeal will

suppress the

appetite

andsmall-

frequent meal

are often better

tolerated.

3. To improve

the nutritional

status.

Goal met.

After 24

hours of

therapeutic

nursing

interventio

n, client

demonstrat

ed good

appetite,

improved

nutrition

status, and

manifested

appropriat

e daily

activities.




Assess

ment


4.Increase fluid intake

5. Arrange dietician to

discuss with client or

family on proper diet

intake and helpful dietary

medifications.

4.To promote good

hydration

5.To improve the

nutritional status.



I. DISCHARGE GOAL

a. Complications prevented/minimized

b. Pain relieved/controlled

c. Dealing with desease realistically

d. Disease process/prognosis and therapeutic

regimen understood

e. Plan in place to needs after discharge



II. Medication



III. Diet



IV.FOLLOW UP VISIT/CHECK-UP



V. IMPORTANT HEALTH TEACHING

INCLUDES

A. Pay attention on medication regimen, dietaryand fluid restriction.

B. Eat well, good nutrition can help to feel

better during treatment and diseasetreatment side effects, decrease risk forinfection, and help to maintain a healthyweight and heal faster (Eat small-frequent

meal and snacks rather than 1 big mealwhich will only suppress the appetite.



C. Drink fluids about 2-3liters each day or

prescribe the Doctor.

D. Avoid constipation. These can irritate the

rectum which can cause infection.

E. Rest (going to bed early and getting up late

may also help)

F. Exercise keeps you healthy.

Decrease activities if blood count is low

based on the result of blood test.



VI. SEEK IMMEDIATELY IF:

A. Have headache, blurred vision, stiff neck, or

have trouble thinking.

B. Coughing out of blood (this may be a serious

bleeding inside the body)

C. Have chest pain

D. Have trouble breathing



VII. NURSING PRIORITIES

A. Prevent infection during acute phases of

disease/treatment

B. Maintain circulating blood volume

C. Alleviate pain

D. Promote optimal physical functioning

E. Provide psychological supportF. Provide information about disease

process/prognosis and treatment



VII. SIGNS OF AN INFECTIONS

A. sores, swelling, redness, or white patches in themouth or throat.

B. Redness, pain, hemorrhoids in the rectum

C. Diarrhea

D. Heat or pain in the eyes, ears, skin, joints, orabdomen

E. Pain or burning when urinating, or bad smelling

urineF. Coughing, trouble breathing or changes in thecolor of sputum



VIII. INFECTION PROTECTION

• Place in room screen/limit visitors as

indicated.

• Prohibit use of live plants/cut flowers. Restrict

fresh fruits and vegetables or make it sure

they are wash or peeled.



IX. BLEEDING PRECAUTIONS

• Inspect skin/mucus membranes for petechiae,

ecchymotic areas, note bleeding gums, frank

or occult blood in the stool and urine, oozing

for invasive line sites

X PAIN MANAGEMENT



X. PAIN MANAGEMENT

• Place in position of comfort and support

joints, extremities, with pillows/padding.

• Evaluate reports of fatigue, inability to

participate in activities.



Summary

Acute lymphocytic leukemia (ALL), also

called acute lymphoblastic leukemia, is a cancer

that starts from white blood cells calledlymphocytes in the bone marrow (the soft inner

part of the bones, where new blood cells are

made).



This study helps the student to:

• Know more about the lymphocytic leukemia.

• Determine the difference between lymphoblastic

and lymphocytic leukemia.• Be familiarized with the different procedures

done to the patient.

• Know more about the appropriate assessments

regarding the lymphocytic leukemia.

• Know the different method and treatments onlymphocytic leukemia.



Recommendations

• For most people, the cause of ALL is unknown.

For this reason, there is no known way to

prevent it. However, there are a few knownrisk factors for this type of leukemia.



Risk Factors

• Avoid Exposure to high levels of radiation to

treat other types of cancer

• Avoid Exposure to certain chemicals such asbenzene, a solvent used in oil refineries and

other industries and present in cigarette

smoke, certain cleaning products, detergents,and paint strippers

http://www.webmd.com/cancer/what-to-expect-from-radiation-therapy

http://www.webmd.com/cancer/what-to-expect-from-radiation-therapy



• Reduce Infection with human T-cell

lymphoma/leukemia virus-1 (HTLV-1) in rarer

cases outside the U.S. or Epstein-Barr virus(EBV), a related leukemia more commonly

seen in Africa.

Case Pres PPT

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