- Chronic Pain related to Chemical agents (chemotherapy treatment) and disease process (bone marrow with excess leukemic cells, enlarged lymph nodes) as evidenced by Expressions of pain and Reports pain intensity
- Fatigue related to Increased mental and physical exertion; Chemotherapy as evidenced by Difficulty maintaining usual physical activity and Difficulty maintaining everyday routines
- Risk for Decreased Cardiac Output related to Cancer cells infiltrating cardiac cells and Inadequate oxygenated blood to the heart and Immunosuppression as evidenced by abnormal ECG and haemodynamic instability
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalize and Expresses Pain Objective Data: -Diaphoresis -Distraction behavior -Guarding behavior -Reports pain intensity -Reports pain characteristics | Chronic Pain related to Chemical agents (chemotherapy treatment) and disease process (bone marrow with excess leukemic cells, enlarged lymph nodes) as evidenced by Expressions of pain and Reports pain intensity | Patient will report a reduced pain level following the administration of pain medication. Patient will verbalize two nonpharmacologic strategies to control pain. | 1. Discuss marijuana compounds. Marijuana has been shown to relieve pain and reduce inflammation. Inhaled or vaporized forms of marijuana can help treat neuropathic pain. 2. Offer complementary therapy. Supportive treatments along with medical treatment can provide symptom relief. This may include meditation, yoga, nutritional support, acupuncture, and more. 3. Provide nonpharmacologic pain relief options. Providing comfort is a priority for patients with oncologic pain. Nonpharmacologic methods to relieve pain include massage, psychological support, diversional activities, heating pads, or ice packs. 4. Administer pain medications as ordered. Analgesics and antianxiety medications may be ordered to help relieve pain and support relaxation in patients with leukemia. For severe pain, opioid medications may be administered as ordered. | Patient reported a reduced pain level following the administration of pain medication. Patient verbalized two nonpharmacologic strategies to control pain. |
| Subjective Data: Objective Data: -Difficulty maintaining everyday routines -Drowsiness -Expresses a lack of energy -Expresses tiredness -Expresses weakness -Inadequate role performance -Exhaustion with minimal activity | Fatigue related to Increased mental and physical exertion; Chemotherapy as evidenced by Difficulty maintaining usual physical activity and Difficulty maintaining everyday routines | Patient will demonstrate ways to increase energy and improve activity performance. Patient will report a boost in energy and ability to perform physical and mental activities. | 1. Encourage the patient to express feelings about fatigue. Allowing patients with leukemia to verbalize feelings about the disease process will help set realistic goals and maintain a sense of control. 2. Discuss mental health support. Counselling may help with understanding and coping with the loss of energy. A therapist can offer strategies to manage brain fog. 3. Encourage asking for help. Treatments for leukaemia require an enormous amount of effort and time. Remind the patient that seeking the assistance of friends and loved ones is expected during this time. 4. Encourage planned exercise activities. Continued physical activity after chemotherapy is associated with improved physical, social and mental functioning and promotes a better quality of life. Children with leukemia will often desire play but may need limits set to not overexert themselves. | Patient demonstrated ways to increase energy and improve activity performance. Patient reported a boost in energy and ability to perform physical and mental activities. |
| Subjective Data: Verbalizes heaviness in heart Objective Data: -Exercising as recommended -Quitting smoking -Maintaining a healthy weight -Limiting alcohol -Reducing the intake of saturated fats, salt, and cholesterol | Risk for Decreased Cardiac Output related to Cancer cells infiltrating cardiac cells and Inadequate oxygenated blood to the heart and Immunosuppression as evidenced by abnormal ECG and haemodynamic instability | Patient will not develop heart failure, endocarditis, or pericarditis. Patient will display normal sinus rhythm on ECG. Patient will verbalize two strategies to prevent developing heart disease. | 1. Discuss lower doses of anthracyclines. If the patient begins experiencing heart-related side effects from these medications, the nurse can collaborate with the healthcare team on lowering doses or switching to a different medication. 2. Refer to a cardiologist. Patients receiving treatment for leukemia are treated by a team of oncologists and hematologists. It may be prudent to involve a cardiologist if cardiac issues arise. 3. Administer prescribed medications. Educate on the addition of medications like ACE inhibitors, beta-blockers, or diuretics to treat manifestations of heart failure such as hypertension and edema. 4. Educate on lifestyle modifications to prevent heart disease. The patient is still in control of keeping their heart as healthy as possible while undergoing treatment for leukemia. | Patient minimized from developing heart failure, endocarditis, or pericarditis. Patient displayed normal sinus rhythm on ECG. Patient verbalized two strategies to prevent developing heart disease. |