Nursing Diagnoses

The top five things that nurses can focus on when caring for patients with leukemia are:

1. Risk for infection, possibly related to altered white blood cell count, tissue damage, bone marrow suppression, immunosuppression, invasive procedures, and malnutrition.
2. Risk for deficient fluid volume, possibly related to excessive fluid loss from vomiting and diarrhea, decreased fluid intake from nausea and anorexia, and an increased fluid need from a hypermetabolic state. 
3. Acute pain, possibly related to enlarged organs, bone marrow packed with leukemic cells, chemical agents, and psychological factors such as anxiety and fear. 
4. Activity intolerance, possibly related to general weakness, reduced energy stores, hypermetabolic state due to massive production of leukocytes, imbalance between oxygen supply and demand, and effects of drug therapy.
5. Deficient information, possibly related to lack of access to resources, information misinterpretation, or lack of recall.

Maintaining as much autonomy and leisure time as possible is a key factor in maintaining optimism for cancer patients, and anyone, for that matter. Let’s focus on the nursing diagnosis of activity intolerance to see what nurses can do to help a CLL patient continue to participate in activities.

Activity Intolerance

May be related to generalized weakness; reduced energy stores, increased metabolic rate from massive production of leukocytes; imbalance between oxygen supply and demand (anemia/hypoxia); therapeutic restrictions (isolation/bedrest); effect of drug therapy

Possibly evidenced by verbal report of fatigue or weakness; exertional discomfort or dyspnea; abnormal heart rate or blood pressure response

Desired outcomes include having the patient report a measureable increase in activity tolerance, participating in activities of daily level to level of ability, and able to demonstrate a decrease in physiological signs of intolerance, including pulse, respiration, and blood pressure remain with patient’s normal range

Nursing Interventions

Evaluate reports of fatigue, noting inability to participate in leisure activities or activities of daily living.  Rationale: Effects of leukemia, anemia, and chemotherapy may be cumulative (especially during acute and active treatment phase), necessitating assistance.

Encourage patient to keep a diary of daily routines and energy levels, noting activities that increase fatigue. Rationale: Helps patient prioritize activities and arrange them around fatigue pattern.

Provide quiet environment and uninterrupted rest periods. Encourage rest periods before meals. Rationale: Restores energy needed for activity and cellular regeneration and/or tissue healing.

Implement energy-saving techniques (Sitting, rather than standing, use of shower chair). Assist with ambulation and other activities as indicated. Rationale: Maximizes available energy for self-care tasks.

Schedule meals around chemotherapy. Give oral hygiene before meals and administer anti-emetics as indicated. Rationale: May enhance intake by reducing nausea.

Recommend small, nutritious, high-protein meals and snacks throughout the day. Rationale: Small meals require less energy for digestion than larger meals. Increased intake provides fuel for energy.

Provide supplemental oxygen. Rationale: Maximizes oxygen available for cellular uptake, improving tolerance of activity.

References:
 Five Leukemia Care Plans. 2015. Retrieved April 4, 2015 from http://nurseslabs.com/5-leukemia-nursing-care-plans/