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Ongoing Fight
Against
LEUKEMIANURSING CARE MANAGEMENT
LEA FOY-OS CAPILI, RN, USRN, MAN
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Quality cancer care is likened to
that of a mother's gift of herself
for the sick child - it is the givingof total understanding and
support to the cancer patient with
love and compassion.
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Out of ~ 3300(IARC estimate)expected childhood cancer newcases each year, only 1000 arecared for and the remaining 2000are neither diagnosed nortreated.
Leukemia and retinoblastoma
account approximately 60% ofthese cases.
only 20% attaining long-termsurvival.
Among the 1000 children, 1 outof 5 receives treatment followinglocal gold standards
International Agency for Research in Cancer
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LEUKEMIAa malignant disorder of theblood and blood-formingorgans bone marrow, lymphnodes, and spleen), resultingin a loss of cell divisionregulation and maturation.
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1. Pertinent patient and family historyExposure to radiation for therapeutic
or non-therapeutic reasons
Exposure to chemicals
Cytotoxic drugs Benzene
Chloramphenicol
Phenylbutazone
Genetic abnormalities
Viral exposures
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2. Physical examinationOral cavity
Abdomen
Lymph node enlargement
Neurological
Musculoskeletal
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3. Evaluation of Laboratory Data
Hematocrit and hemoglobinlevels
WBC count with abnormaldifferential
Platelet count
CSF analysis
Liver function test values
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Potential for injury relatedto easy bruising or
bleeding tendencies.
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Impaired socialinteraction related to
prolonged hospitalization.
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Potential for impaired skinintegrity due to skin
infiltration of parenteral
anticancer drugs.
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Susceptibility to infectionrelated to ineffective
defense mechanisms.
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Alteration in nutrition:less than body
requirement due to
anorexia or vomiting.
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Potential for impairedrenal functions related to
nephrotoxic effects of
chemotherapy.
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Body image disturbancerelated to side effects of
some anticancer drugs.
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LEUKOSTASISAssess neurological status for
signs and symptoms of bleedingevery four hours
Institute additionalenvironmental and personalsafety measures
Assess for changes in respiratory
and status indicative of variousthrombosis
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INFECTIONMaintain patients skin integrity, sleep
and nutrition
Decrease invasive procedures
Provide private room
Prevent exposure to any person withviral or bacterial infections
Instruct patient on proper hygiene Patient and caregivers should practice
meticulous hand washing
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DISSEM INATED INTRAVASCULAR
COAGULATION
Prevent injury
Decrease invasiveprocedures
Monitor laboratoryresults
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ORAL COMPLICATIONSProvide routine oral care
Instruct to use toothbrushwith soft bristles
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Consider:
1. Type of the leukemia and treatment2. Side effects manifestations
3. Self-care measures
4. Manifestations of recurrent diseases
5. Self-care skills
6. Support system7. Institutional policies
8. Referral services
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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
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QUALITYCANCER CARE
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1. Comfort
2. Safety3. Nutrition
4. Oral and skin care
5. Alleviation of pain6. On time medication
7. Respecting
8. Recreation and relaxation periods
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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 sayand do.
13.Privacy and autonomy of the patient.
14.Friendship and collegiality.15.Have a parental heart and attitude.
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DAME CECILY SAUNDERS:
You matter because you are you!
You matter to the last moment o f
your l ife,And we w i ll do al l we can,
Not on ly to help you d ie in peace,
But also to l ive unt i l you die.