Ongoing Fight Against LEUKEMIA

NURSING CARE MANAGEMENT

LEA FOY-OS CAPILI, RN, USRN, MAN

Quality cancer care is likened to that of a mother's gift of herself for the sick child - it is the giving of total understanding and support to the cancer patient with love and compassion.

 Out of ~ 3300 (IARC estimate) expected childhood cancer new cases each year, only 1000 are cared for and the remaining 2000 are neither diagnosed nor treated. Leukemia and retinoblastoma account approximately 60% of these cases. only 20% attaining long-term survival. Among the 1000 children, 1 out of 5 receives treatment following local gold standards
International Agency for Research in Cancer

LEUKEMIA
a malignant disorder of the blood and blood-forming organs (bone marrow, lymph nodes, and spleen), resulting in a loss of cell division regulation and maturation.

1. Pertinent patient and family history Exposure to radiation for therapeutic or non-therapeutic reasons Exposure to chemicals
Cytotoxic drugs Benzene Chloramphenicol Phenylbutazone

Genetic abnormalities Viral exposures

2.

Physical examination

Oral cavity Abdomen Lymph node enlargement Neurological Musculoskeletal

3. Evaluation of Laboratory Data

Hematocrit and hemoglobin levels WBC count with abnormal differential Platelet count CSF analysis Liver function test values

Potential for injury related to easy bruising or bleeding tendencies.

Impaired social interaction related to prolonged hospitalization.

Potential for impaired skin integrity due to skin infiltration of parenteral anticancer drugs.

Susceptibility to infection related to ineffective defense mechanisms.

Alteration in nutrition: less than body requirement due to anorexia or vomiting.

Potential for impaired renal functions related to nephrotoxic effects of chemotherapy.

Body image disturbance related to side effects of some anticancer drugs.

LEUKOSTASIS
Assess neurological status for signs and symptoms of bleeding every four hours Institute additional environmental and personal safety measures Assess for changes in respiratory and status indicative of various thrombosis

INFECTION
Maintain patients skin integrity, sleep and nutrition Decrease invasive procedures Provide private room Prevent exposure to any person with viral or bacterial infections Instruct patient on proper hygiene Patient and caregivers should practice meticulous hand washing

DISSEMINATED INTRAVASCULAR COAGULATION Prevent injury Decrease invasive procedures Monitor laboratory results

ORAL COMPLICATIONS
Provide routine oral care Instruct to use toothbrush with soft bristles

Consider:
1. 2. 3. 4. 5. 6. 7. 8. Type of the leukemia and treatment Side effects manifestations Self-care measures Manifestations of recurrent diseases Self-care skills Support system Institutional policies Referral services

 Freedom from injury and infection Consumption of adequate calories balanced among basic food groups Intact skin and mucous membrane Absence of abnormal bleeding Adequate urine output negative for occult blood Decreased discomfort and absence of pain High self-esteem Compliance to prescribed treatment

QUALITY CANCER CARE

1. 2. 3. 4. 5. 6. 7. 8.

Comfort Safety Nutrition Oral and skin care Alleviation of pain On time medication Respecting Recreation and relaxation periods

9. Respecting silence 10.Clarification of personal and family values 11.Spiritual dimensions of prayer and ritualistic practices 12.Constancy of presence and congruence between what you say and do. 13.Privacy and autonomy of the patient. 14.Friendship and collegiality. 15.Have a parental heart and attitude.

DAME CECILY SAUNDERS:

You matter because you are you! You matter to the last moment of your life, And we will do all we can, Not only to help you die in peace, But also to live until you die.