CHRONIC MYELOGENOUS
LEUKEMIA
GROUP D
I. INTRODUCTION
CASE DESCRIPTION
 Chronic myeloid leukemia is a slow-growing cancer of the blood-forming
tissue (bone marrow). Normal bone marrow produces red blood cells
(erythrocytes) that carry oxygen, white blood cells (leukocytes) that protect
the body from infection, and platelets (thrombocytes) that are involved in
blood clotting. In chronic myeloid leukemia, the bone marrow produces too
many white blood cells. Initially, these cells function relatively normally.
However, as the condition progresses, immature white blood cells called
myeloblasts (or blasts) accumulate in the blood and bone marrow. The
overgrowth of myeloblasts impairs development of other blood cells, leading
to a shortage of red blood cells (anemia) and platelets.
I. INTRODUCTION
RISK FACTORS
• Age
• Radiation Exposure
• Gender
I. INTRODUCTION
Etiology
 CML is caused by a genetic change (mutation) in the stem cells
produced by the bone marrow. The mutation causes the stem
cells to produce too many underdeveloped white blood cells. It
also leads to a reduction in the number of other blood cells, such
as red blood cells.The change involves bundles of DNA called
chromosomes. Within each stem cell, a section of DNA from one
chromosome swaps with a section from another. This change is
known as the "Philadelphia chromosome".
I. INTRODUCTION
Signs and symptoms
•
•
•
•
•
•
•
•
•
Fatigue or weakness, such as shortness of breath while doing everyday activities
Fever
Excessive sweating, especially at night
Weight loss
Abdominal swelling or discomfort due to an enlarged spleen. This may be particularly
noticeable in the upper left part of the abdomen.
Feeling full when you have not eaten much
Itching
Bone pain
Bleeding
I. INTRODUCTION
Diagnostic tests
• ABO group
• Rh type
• Covid-19 antigen
• Creatinine
• Hematology
I. INTRODUCTION
Complications
• Hepatomegaly and/or splenomegaly
• Worsening anemia
• Changes in platelet count changes resulting in clotting or
bleeding complications
• Recurrent infections
• Bone pain
• Fever
I. INTRODUCTION
Treatment option
• Targeted therapy
• Chemotherapy
• Immunotherapy
• High-dose chemotherapy with stem cell transplant
• Donor lymphocyte infusion (DLI)
• Surgery
II. ANATOMY AND PHYSIOLOGY
Anatomy of the bone. The bone is made up of compact bone, spongy bone, and
bone marrow. Compact bone makes up the outer layer of the bone. Spongy
bone is found mostly at the ends of bones and contains red marrow. Bone
marrow is found in the center of most bones and has many blood vessels. There
are two types of bone marrow: red and yellow. Red marrow contains blood stem
cells that can become red blood cells, white blood cells, or platelets. Yellow
marrow is made mostly of fat.
Normally, the bone marrow makes blood stem cells (immature cells) that
become mature blood cells over time. A blood stem cell may become a myeloid
stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a white blood
cell.
A myeloid stem cell becomes one of three types of mature blood cells:
*Red blood cells that carry oxygen and other substances to all tissues of the body.
*Platelets that form blood clots to stop bleeding.
*Granulocytes (white blood cells) that fight infection and disease.
In CML, too many blood stem cells become a type of white blood cell called
granulocytes. These granulocytes are abnormal and do not become healthy
white blood cells. They are also called leukemia cells. The leukemia cells can
build up in the blood and bone marrow so there is less room for healthy white
blood cells, red blood cells, and platelets. When this happens, infection, anemia,
or easy bleeding may occur.
III. NURSING HISTORY
BIOGRAPHIC DATA
Name: Patient XYZ
Gender: Male
Age: 38Y4M30D
Birth Date: 08-07-1984
Birth Place: Alicia Isabela
Address: P-1 Amobocan, Cauayan City, Isabela 3305
Status: Widowed
Religion: Roman Catholic
Nationality: Filipino
Height: 180 cm
Weight: 62 kg
Chief Complaint: Easy fatigability
Date of Admission: 01-06-23
Time of Admission: 1:40 pm
Admitting Diagnosis: Chronic Myelogenous Leukemia (CML)
Admitting Physician: Kings Lee Jay L. Corpuz, MD.
Attending Physician: Joy Tabuno Aquino
III. NURSING HISTORY
Vital signs upon admission
Blood pressure: 120/80
Temperature: 38.5
Heart rate: 86
Respiratory rate: 11
III. NURSING HISTORY
HISTORY OF PRESENT ILLNESS
 Patient is known case of myeloproliferative neoplasm on
hydroxyurea however non-complaint, patient experienced body
weakness for long duration, CBC done revealed elevated WBC
count, advised admission and was subsequently admitted.
PAST HEALTH HISTORY/FAMILY HISTORY
 With leukemia from the mother side
 With heart disease from the mother side
IV. GORDON’S STRUCTURAL PATTERN
HEALTH PERCEPTION
PATTERN
BEFORE
HOSPITALIZATION
The patient viewed himself
in a state where he cannot
perform his daily activities
with the presence of his
illness.
DURING
HOSPITALIZATION
The patient stated that he
feels healthier and better.
the patient is willing to
accept and listen to the
health teaching and shows a
desire to recover. He takes
all of his medication and
follows his doctor's order
for his fast recovery.
IV. GORDON’S STRUCTURAL PATTERN
BEFORE
DURING
HOSPITALIZATION HOSPITALIZATION
NUTRITIONAL
METABOLIC PATTERN
The patient has no The patient is in
allergies to foods DAT
and drugs and he
eats 3 times a day.
IV. GORDON’S STRUCTURAL PATTERN
ELIMINATION
PATTERN
BEFORE
HOSPITALIZATION
The patient usually
voids 3 times a day and
defecates twice a day.
The patient has no
problems with urinating
or defecating.
DURING
HOSPITALIZATION
The patient can urinate
and defecate on her
own. The patient
usually voids 3 times a
day. The patient has no
problems with urinating
and defecating.
IV. GORDON’S STRUTURAL PATTERN
BEFORE
HOSPITALIZATION
ACTIVITY – EXERCISE The patient stated that
PATTERN
he has no difficulty in
breathing, but he easily
gets tired due to his
illness.
DURING
HOSPITALIZATION
The patient stated that
he has difficulty in
breathing.
IV. GORDON’S STRUCTURAL PATTERN
BEFORE
HOSPITALIZATION
COGNITIVEThe patient is alert and
PERCEPTIAL PATTERN oriented to time, place,
and people he is with.
He doesn't have
difficulty in formulating
his sentences. The
patient responds
quickly and hears
clearly. Moreover, he
doesn't experience
memory lost.
DURING
HOSPITALIZATION
The patient is alert and
oriented to time, place,
and people he is with.
He doesn't have
difficulty in formulating
his sentences. The
patient responds quickly
and hears clearly.
Moreover, he doesn't
experience memory
lost.
IV. GORDON’S STRUCTURAL PATTERN
BEFORE
HOSPITALIZATION
SLEEP-REST PATTERN The patient sleeps 8
hours, his earliest time
is at 8:00 pm and wakes
up at 2:00 am,
sometimes he takes a
nap at noon for about
an hour.He have some
difficulties going to
sleep due to his illness.
DURING
HOSPITALIZATION
The patient sleeps at
9:00 pm and wakes up
at 4:00 am, he can
consumed 9 hours of
sleep, he takes a nap at
noon for about 1-2
hours. His body is more
relax because of the
medication he is taking.
IV. GORDON’S STRUCTURAL PATTERN
SELF-PERCEPTION
BEFORE
HOSPITALIZATION
The patient was able to
express his feelings
about hes condition, he
is contented working for
him and his children.
DURING
HOSPITALIZATION
The patient state that
he believes that
admission will be
helpful to adjust his
needs and will alleviate
the occurrence of his
condition.
IV. GORDON’S STRUCTURAL PATTERN
ROLE-RELATIONSHIP
PATTERN
BEFORE
HOSPITALIZATION
The patient plays the
role of the head of the
family. She spend most
of his time working.
DURING
HOSPITALIZATION
The patient is wellsupported by his family.
He receives positive
reinforcement that
provided his comfort
and reassurance.
IV. GORDON’S STRUCTURAL PATTERN
SEXUALITYREPRODUCTIVE
BEFORE
HOSPITALIZATION
The patient is not
sexuality active due to
the fact that his wife
had past away.
DURING
HOSPITALIZATION
The patient is not
sexuality active due to
the fact that his wife
had past away.
IV. GORDON’S STRUCTURAL PATTERN
BEFORE
HOSPITALIZATION
COPING/STRESS
The patient copes up
TOLERANCE PATTERN with stress by watching
t.v., working and using
his cellphone for
entertainment .
DURING
HOSPITALIZATION
The patient takes a nap
and rest, and
sometimes uses his
phone to entertain
himself. He verbalizes
desired to recover, and
was able to accept
situation by cooperating
with the medical
advices.
IV. GORDON’S STRUCTURAL PATTERN
VALUE-BELIEF
PATTERN
BEFORE
HOSPITALIZATION
The patients religious
affiliation is roman
catholic, he also never
forgets to pray and ask
for forgiveness and
good health to the Lord.
DURING
HOSPITALIZATION
The patient never blame
GOD for his condition,
the patient’s
relationship with GOD
remained unchanged.
V. PHYSICAL ASSESSMENT
The patient is wearing white t-shirt and red short
pants. He is alert and oriented to time, place, and
people he is with. His skin color was appropriate to
his ethnicity. The patient is on the bed in a supine
position with knee slightly flex. He was able to walk
and stand on his own. Another, the patient was able
to respond clearly and has no hearing difficulties.
V. PHYSICAL ASSESSMENT
HEAD
Scalp
InspectionPalpation
Hair
Inspection
Palpation
Face
Eyes and vision
Inspection
Inspection
Clean and dry
No lumps
Hair is messy
No dandruff
No hair loss
Black in color
Normocephalic
SymmetryPupil are equal and
round
No blurry vision
pale conjunctivae
Ears and hearing
Inspection
Nose
Inspection
Lips
Inspection
Ears are the same size
Ears are clean
No hearing difficulties
Able to sniff through each
nostril
Lip color: brownish
Normal
Normal
Normal
Normal
due to the effect of
the disease
Normal
Normal
Normal
V. PHYSICAL ASSESSMENT
NECK
Neck
Inspection
Palpation
CHEST AND BACK
Skin
Inspection
Lungs
Inspection
Auscultation
Abdomen
Inspection
Palpation
Able to move freely
Symmetric with head
centered
Normal
No lesions
No rushes
RR: 11bpm
dyspnea
Normal
Bloated
Blood
transfusion
reaction
Enlargement
of organs
V. PHYSICAL ASSESSMENT
UPPER EXTREMITIES
Skin
Inspection
Palpation
Muscle strength
Inspection
Capillary refill
Inspection
Palpation
Radial pulse
Palpation
LOWER EXTREMITIES
Skin
Inspection
Palpation
Ankle and foot
Palpation
Color: brown
Texture: normal
Active muscle strength
-Nails are long and brittle
-Nail beds are darken
-More than 2 seconds
capillary refill
No rashes
palpable
No lesions
No rushes
Texture: normal
No signs of edema
Normal
Normal
Effect of the
disease
Normal
Normal
Normal
VI. LABORATORY DIAGNOSTIC TEST
HEMATOLOGY
Red cell count
Haematocrit
Haemoglobin
White cell count
Diff. count
Lymphocytes
Monocytes
Eosinophils
Basophils
Segmenters
MCV
MCH
MCHC
RDW-CV
Platelet count
MPV
01-06-23(10:10
am)
2.1 LOW
0.20 LOW
73 LOW
490.4 HGH
01-08-2023(3:30
pm)
1.8 LOW
0.18 LOW
62 LOW
343.2 HIGH
01-10-2023
NORMAL VALUES
2.2 LOW
0.22 LOW
71 LOW
254.0 HIGH
4.0 - 6.0 x 10^12/L
0.40 - 0.54
130 -180 g/L
5.0 – 10.0 x 10^9/L
0.11 LOW
0.23 HIGH
0.05
0.01
0.60
0.09 LOW
0.17 HIGH
0.04
0.00
0.70 HIGH
0.18 LOW
0.07
0.02
0.01
0.72 HIGH
0.25 – 0.35
0.03 – 0.14
0.01 – 0.06
0.00 – 0.01
0.50 – 0.65
97
35
37
22.9 HIGH
350
10.2
96
34
35
22.7 HIGH
237
10.6
97
32
33
21.1 HIGH
183
11.1
86 – 110 fL
26 – 38 pg
31.000 – 37.000 g/dL
11.000 – 16.000 %
150 – 450 x 10^9/L
6.5 – 12.0 fL
VI. LABORATORY DIAGNOSTIC TEST
SEROLOGY/IMMUNOLOGY (01-06-2023, 2:49
pm)
TEST
ABO Group
RH Type
RESULT
O
Positive
VI. LABORATORY DIAGNOSTIC TEST
SEROLOGY/IMMUNOLOGY (01-06-2023, 2:13 pm)
TEST
COVID – 19 Antigen
RESULT
Negative
VII. PATHOPHYSIOLOGY
Translocation of a Chr 9
segment onto Chr 22,
creating a Philadelphia
Chromosome (Chr 22)
containing the BCR-ABL1
fusion gene.
Mutations from
ionizing radiation.
Other genetic
abnormalities.
The genetic abnormalities accumulate in the earliest
cell of the blood cell differentiation sequence: the
pluripotent hematopoietic stem cell
Hematopoietic stem cell division in the bone
marrow becomes unregulated
Chronic Stage (85% of clinical
presentation): hematopoietic stem
cell division/differentiation in the
bone
marrow
result
increase
production of multiple blood cell lines
(detectable on CBC, but patients are
usually asymptomatic at this stage)
Multifactorial causes, most
with unclear mechanisms
Weight loss, malaise,
fever/chills, night sweats
Neoplastic division of platelet
precursor cells
Thrombocytes
Leukocytes:
Neoplastic division of WBC
precursor cells, especially
neutrophil precursors
-Neutrophilia, basophilia,
& eosiphilia
-“Left shift”: increase
neutrophil & band
production
-Disorderly WBC
differential: i. e.
“myelocyte bulge”
Trapping of WBC’s in
the spleen enlarges
the spleen
Splenomegaly:
-Left upper quadrant pain
-Early satiety (large spleen
compresses the stomach)
-Associated hepatomegaly
(if spleen is overfilled &
WBC’s spill over into liver)
VIII. COURSE IN THE WARD
TIME AND DATE
01-06-20231:30 pm
RATIONALE
 Please admit under the service of Joy
Tabuno Aquino
 For further monitoring, management, and
evaluation of the patient's condition.
 Secure chart
 For more accurate diagnosis and develop
treatment plans with better outcomes.
 DAT
 To maintain patient's nutritional status.
 VS every 4 hour except at bedtime
 To monitor deviation from normal values.
 IVF: #1 PNSS 1 L x 8°
#2 PNSS 1 L x 8°
#3 PNSS 1 L x 8°
 To reduce some types of bacteria.
 LAB: Blood typing
Creatinine
 To receive a blood transfusion safely.
 To help assess kidney function.
 Meds: Hydroxyurea,Febuxostat,
Sleepwell
 To treat cancer by slowing or stopping the
growth of cancer cells in your body.
 To prevent gout attacks but not to treat
them once they occur.
 To treat anxiety and employed as a shortterm treatment of insomnia.
VII. COURSE IN THE WARD
1-07-202312:50 pm
 Increase hydroxyurea to
 This medication is used by
3caps off bf 3caps off lunch
people with sickle cell
2caps off dinner
anemia to reduce the
number of painful crises
caused by the disease and
to reduce the need for blood
transfusions.
 Continue medication
 To control the condition,
treating overall health and
well-being.
 IVF #4 PNSS 1L x 8°
#5 PNSS 1L x 8°
#6 PNSS 1L x 8°
 To reduce some type of
bacteria.
VII. COURSE IN THE WARD
1-08-2023
 2:18 pm
 IV. #7 PNSS 1L x 12°
#8 PNSS 1L x 12°
 To reduce some type of bacteria
 5:11 pm
 For BT of 1 unit PRBC properly typed
and crossmatched divided into 2
Aliquots, each aliquot to run for 3 hours /
12 hours apart.
 To avoid serious or even life-threatening
transfusion reaction.
 IVF to 16 hours while on BT
 To restore blood volume, restore oxygencarrying capacity of blood with red blood
cells.
 5:49 pm
 Pre BT med: diphenhydramine 25mg cup  To make you drowsy (sedating)
antihistamine and is more likely to make
you feel sleepy than other
 Temperature 38°C
antihistamines.
 500 mg tablet Q4°for temperature 37.8
above or paracetamol 300 mg IV Q4°for
temperature 38.5°Cand above.
 TSB
 To analyze the effectiveness of
treatment.
 To help treat pain and reduce a high
temperature (fever).
 Request for CXR (PA) and urinalysis with
recurrence of fever.
 To lower his temperature
 To screen for more diagnosis and
VII. COURSE IN THE WARDS
1-09-2023
12:45 pm
 Continue medication
 To control the
condition, treating
overall health and wellbeing.
 Reserved 2 unit PRBC
Decrease
 To replace any blood
loss.
 IVF to 16°
 To prevent premature
ovulation and thus
improve IVF success.
 CBC, for repeat 6 PM
tomorrow
 To screen for, help
diagnose, and monitor
VII. COURSE IN THE WARD
01-10-2023
12:11 pm
 Rely CBC result when available
tonight
 To evaluate overall health and
detect a wide range of disorder
 For BT 1 unit of PRBC properly
types and crossmatched, divided
into 2 aliquots
 To avoid serious or even lifethreatening transfusion reaction.
 IVF to 20 hours while on BT
 To restore blood volume, restore
oxygen-carrying capacity of blood
with red blood cells.
 PRN BTDiphenhydramine,
Paracetamol
 To make you drowsy (sedating)
antihistamine and to help treat pain
and reduce a high temperature
(fever).
9:03 pm
 Given PRN BT medications on
1staliquot only
 Reserve 1 unit PRBC
 To replace any blood loss.
IX. NURSING CARE PLAN
ASSESSMENT
SUBJECTIVE:
•
•
•
•
•
NURSING
DIAGNOSIS
Ineffective
breathing pattern
OBJECTIVE:
related to blood
Labored
transfusion
breathing
reaction as
Dyspnea
evidence by
O2 sat of 94
Respiratory rate labored
of 11
breathing,
Chief complaint:
dyspnea, O2 sat
Easy fatigability
of 94, and
respiratory rate of
11.
PLANNING
After 8 hours of
nursing
intervention, the
patient will
maintain an
effective
breathing pattern
as evidenced by
the absence of
dyspnea and
normal O2 sat
and respiratory
rate
INTERVENTION
RATIONALE
Independent
 Note rate and depth of respiration

 Changes in patient’s breathing
pattern can indicate adverse
reactions from a blood transfusion
 Monitor oxygen saturation
 To verify improvement in oxygen
saturation
 Encourage slower and deeper
respirations
 To assist the patient in taking
control of the situation
 Place the patient in appropriate
position for clearing airways
 Proper positioning enables optimal
breathing pattern
 Encourage adequate rest periods
 To limit fatigue
 Note emotional state
 Emotional changes can accompany
a condition or precipitate or
aggravate ineffective breathing
pattern
 Stay with the patient during
episode of respiratory distress
 Staying with the patient can help
lessen the patient’s anxiety which
can lessen oxygen demand as well
Dependent
 Administer diphenhydramine as
prescribed by the doctor
 In case the patient will have fever or
allergy during blood transfusion
EVALUATION
After 8 hours of
nursing intervention,
the patient was able
to maintain an
effective breathing
pattern as evidenced
by the absence of
dyspnea and normal
O2 sat and
respiratory rate. Goal
met.
ASSESSMENT
SUBJECTIVE:
" habang
sinasalinan ako ng
dugo, bigla akong
nilagnat" as
verbalized by the
patient
OBJECTIVE:
-Temp: 38.5
- Skin warm to
touch
- Lethargy
- Flushed skin
NURSING DIAGNOSIS
PLANNING
Hyperthermia related
to adverse effect
from blood
transfusion as
evidence by body
temperature of 38 .5
and skin warm to
touch.
After 8 hours of
nursing intervention
the patient will be
able to maintain body
temperature within
normal range.
INTERVENTION
Dependent:
 Monitor vital signs.
 Provide tepid sponge
bath.
 Make use of cooling
blanket as needed.
 Maintain bed rest.
 Provide patients
safety such as raise
the bed side rails.
 Discuss importance of
adequate fluid intake.
Independent:
 Administer
paracetamol as
indicated.
RATIONALE
Dependent:
 To have a baseline
data.
 To promote heat loss
by evaporation.
 A cooling blanket will
help to reduce the
patient’s elevated bod
temperature.
 To reduce metabolic
demands and oxygen
consumption.
 To prevent further
injuries.
 To prevent
dehydration
Independent:
 Paracetamol will aid in
the reduction of the
patient’s body
temperature
EVALUATION
•
After 8 hours of
nursing
intervention the
patient was able
to maintain body
temperature
within normal
range. goal met
IX. NURSING CARE PLAN
ASSESSMENT
OBJECTIVE:
Wt. 62kg
Ht. 180 cm
•
Easy
fatigability
NURSING
DIAGNOSIS
Risk for
Infection related
to the
immunosuppres
sed state.
PLANNING
After 8 hours
of nursing
intervention
the patient
will remain
free from
infection.
INTERVENTION
RATIONALE
1.
Monitor CBC values
1.
2.
Isolate the patient and admit
them to a private room
2.
3.
Always perform hand washing
before and after caring for the
patient Promote infection
control measure
3.
Hand hygiene is important to
prevent the possibility of cross
contamination and the risk of
infection Infection control
interventions like changing IV
tubing, proper skin care, and
oral hygiene can help reduce
the risk of infection.
4.
Provide a nutrition diet and
refer to a dietician as
necessary
4.
Providing adequate nutrition
can help enhance the patients’
immune system reducing the
risk of infection
EVALUATION
To continue monitoring changes After 8 hours of
in these values, and to have
nursing
baseline data
intervention the
patient is remain
Placing the patient in a private
free from
room with limited visitors can
infection
protect the patient from
potentially pathogens
IX. NURSING CARE PLAN
ASSESSMENT
SUBJECTIVE:“
Nanghihina ako” as
verbalized by the
patient
Objective:
WT: 62kg
HT: 180cm
Vital Signs
BP: 120/80 mmHg
HR: 86O2: 94
T: 38.5
RR: 11
• elevated WBC
• easy fatigability
NURSING DIAGNOSIS
Activity intolerance
related to body
weakness possibly
evidenced by verbal
reports of fatigue or
weakness.
PLANNING
After 8 hours of
nursing intervention
the client will be able
to:
• Report a
measurable
increase in
activity
intolerance.
• Participate in
ADLs to level of
ability.
• Demonstrate a
decrease in
physiological
signs of
intolerance e.g.
maintain vital
signs within
normal range.
INTERVENTION
1.
2.
3.
Evaluate reports 1.
of fatigue, noting
inability to
participate in
ADLs
Encourage
patient to keep a
diary of daily
routine and
2.
energy levels,
noting activities
that increase
fatigue.
Implement
3.
energy-saving
techniques
(sitting, rather
than standing,
use of shower
chair.) Assist
with ambulation
and other
activities as
indicated.
RATIONALE
Effects of
leukemia,
anemia, and
chemotherapy
may be
cumulative,
necessitating
assistance.
Helps prioritize
activities and
arrange them
around fatigue
patterns
Maximize
available energy
for self-care
tasks.
EVALUATION
After 8 hours of
nursing intervention
the client was able
to:
• Report a
measurable
increase in
activity
intolerance.
• Participate in
ADLs to level of
ability.
• Demonstrate a
decrease in
physiological
signs of
intolerance e.g.
maintain vital
signs within
normal range.
- goal met
ASSESSMENT
SUBJECTIVE:
Objective:
•
•
•
looks tired
easy fatigability
inability to
maintain usual
level of physical
activity
RBC: 2.2
Hgb: 71 g/dL
Hct: 0.22 %
Platelet count: 183
Oxygen saturation:
94 %
BP: 120/80 mmHg
IX. NURSING CARE PLAN
NURSING DIAGNOSIS
Fatigue related to
decreased
hemoglobin and
diminished oxygencarrying capacity of
the blood as
evidenced by report
of fatigue and lack of
energy.
PLANNING
INTERVENTION
1.
After 8 hours of
nursing intervention
the client will be able
to:
• Verbalize
understanding on
the use oenergy
2.
conservation
principles.
• Verbalize
reduction of
fatigue, as
evidenced by
reports of
increased energy
and ability to
3.
perform desired
activities.
4.
RATIONALE
Assist the client in
developing a
schedule for daily
activity and rest,
noting the
importance of
frequent rest
periods.
Educate energconservetion
techniques.
1.
Anticipate the need
for the transfusion
of packed RBCs.
3.
Refer the client and
family to an
occupational
therapist.
4.
2.
A plan that
balances periods of
activity with rest
periods can help
the client complete
desired activities
withoutadding
fatigue levels.
Clients and
caregivers may
need to learn skills
for delegating tasks
to others, setting
priorities, and
clustering care to
use the available
energy to complete
desired activities.
Packed RBCs
increase the
oxygen-carrying
capacity of the
blood.
The therapist can
evaluate the need
for additional
energyconservation
measures in the
home setting.
EVALUATION
After 8 hours of
nursing intervention
the client is able to:
• Verbalize
understanding on
the use of energy
conservation
principles.
• Verbalize
reduction of
fatigue, as
evidenced by
reports of
increased energy
and ability to
perform desired
activities.
• - goal met
X. DRUG STUDY
DRUG NAME
Generic Name:
Hydroxyurea
Brand Name:
Droxia
Classification:
Antineoplstics
Dosage/
Frequency/
Timing/ Route:
500 mg/cap
MECHANISM OF
ACTION
INDICATION
May inhibit DNA  Base dosage in
patient’s actual or
synthesis
CONTRAINDICATION
ADVERSE EFFECTS
 Contraindicated in
CNS: malaise, fever,
patients hypersensitive drowsiness
ideal weight,
to drug or its
whichever is less.
components.
GI: anorexia, nausea,
Dosage adjustment is
vomiting, diarrhea,
recommended in
 Use cautiously in
stomatitis, constipation
renal impairment.
patients with renal
 Carcinoma of the
dysfunction and in the HEMATOLOGIC:
head (excluding lip)
elderly
leukopenia,
and neck, with
thrombocytopenia,
radiation (Hydrea)
 Don’t initiate treatment anemia, macrocytosis,
if bone marrow
megaloblastosis
 Resistant chronic
myelocytic leukemia
function is markedly
(Hydrea)
depressed. Bone
marrow suppression
 To reduce frequency
may occur, and
of painful crises and
leukopenia is generally
need for blood
its first and most
transfusions in adult
patients with sickle
common
cell anemia with
manifestation.
recurrent moderate to
Thrombocytopenia and
severe painful crises
anemia occur less
(Droxia, Siklos)
often, and are seldom
seen without a
preceding leukopenia.
NURSING
RESPONSIBILITIES
 Droxia may cause
severe
myelosuppresion.
Monitor blood counts
at baseline and
throughout therapy.
Treatment interruption
and dosage reductions
may be needed
 Blood transfusions
may be necessary for
cumulative
anemiaAdvise patient
to watch for signs and
symptoms of infection
and to take
temperature daily
 Drug may increase risk
of hyperuricemia.
Monitor fluid intake
and output; keep
patient hydrated
X. DRUG STUDY
DRUG NAME
Generic Name:
Febuxostat
Brand Name:
Uloric
MECHANISM OF
ACTION
INDICATION
Reduces uric
•
acid production
by inhibiting
xanthine
oxidase
Classification:
Antigout drugs
Dosage/
Frequency/
Timing/ Route:
40 mg/tab
•
Only use drug in
patients who
have an
inadequate
response to a
maximally titrated
dose of
allopurinol, or for
whom treatment
with allopurinol
isn’t advisable
Chronic
management of
hyperuricemia
associated with
gout
CONTRAINDICATION
•
•
•
•
Contraindicated in
patients hypersensitive
to drugs or to its
components and in those
taking azathioprine,
mercaptopurine, or
didanosine
Use cautiously in
patients with severe
hepatic impairment or
renal impairment
Use cautiously in
patients reporting serious
skin reactions to
allopurinol
Not recommended for
the treatment of
asymptomatic
hyperuricemia
ADVERSE EFFECTS
 CNS: dizziness
 GI: nausea
 HEPATIC: liver
function
abnormalities
 MUSCULOSKELET
AL: arthralgia
 SKIN: rash
NURSING
RESPONSIBILITIES
•
•
•
•
•
Monitor patients for signs
and symptoms of
hypersensitivity or severe
skin reactions
Monitor uric acid level
Patient taking drug may be
at risk for thromboembolic
events, such as MI and
stroke. Monitor patient
closely.
Instruct patient to report
signs and symptoms of
severe skin reactions
immediately
Inform patient that drug
may increase risk of MI and
stroke. Advise patient to
report all adverse
reactions, including
abnormal bleeding,
nausea, malaise, lightcolored stools, yellowing of
eyes or skin, rash, chest
pain, dyspnea, or
neurologic symptoms of a
stroke.
X. DRUG STUDY
DRUG NAME
MECHANISM OF
ACTION
Generic Name:
Competes with •
Diphenhydramine histamine for
H1-receptor
Brand Name:
sites. Prevents
Benadryl
but doesn’t
reverse,
Classification:
histamine
Antihistamines
mediated
•
responses,
Dosage/
particularly
•
Frequency/
those of the
Timing/ Route:
bronchial
25mg/cap
tubes, GI tract,
uterus, and
blood vessels.
INDICATION
Rhinitis,
allergy
symptoms,
motion
sickness,
Parkinson
disease
Night time
sleep aid
Nonproductive
cough
CONTRAINDICATION
•
•
•
Contraindicated in
patients hypersensitive to
drug and other similar
antihistamines, in
newborns, and in
premature neonates.
Use cautiously in patients
with angle-closure
glaucoma, stenosing
peptic ulcer, symptomatic
prostatic hyperplasia,
bladder neck obstruction,
pyloroduodenal
obstruction, or asthma
Use with caution in
patients with prostatic
hyperplasia, asthma,
COPD, increased IOP,
hyperthyroidism, CV
disease, and HTN
ADVERSE EFFECTS
•
•
•
•
•
CNS: drowsiness,
sedation, sleepiness,
dizziness,
icoordination, seizures,
confusion, insomnia,
headache, vertigo,
fatigue, restlessness,
tremor, nervousness
CV: palpitations,
hypotension,
tachycardia
EENT: diplopia, blurred
vision, tinnitus, nasal
congestion
GI: dry mouth, nausea,
epigastric distress,
vomiting, diarrhea,
constipation, anorexia
HEMATOLOGIC:
thrombocytopenia,agra
nulocytosis, haemolytic
anemia
NURSING
RESPONSIBILITIES
•
Stop drug 4 days
before diagnostic
skin testing.
•
Dizziness, excessive
sedation, syncope,
toxicity, paradoxical
stimulation, and
hypotension are more
likely to occur in
elderly patients.
Tell patient to take
diphenhydramine
with food or milk to
reduce GI distress.
Tell patient to notify
prescriber if tolerance
develop because a
different
antihistamine may
need to be
prescribed.
•
•
X. DRUG STUDY
DRUG NAME
1.
2.
MECHANISM OF
ACTION
INDICATION
Paracetamol
500 mg
tablet Q4°for
temperature
37.8 above
- Analgesic-antipyretic
Antipyretic:
Reduces fever by in patients with aspirin
allergy, hemostatic
acting directly on distrubances, bleeding
the hypothalamic diatheses, upper GI
disease, gouty
heat-regulating
arthritis.
Paracetamol center to cause
300 mg IV
vasodilation and - Arthritis and
Q4°for
rheumatic disorders
sweating, which
temperature
involving
helps dissipate
38.5°Cand
muscoloskeletal pain
heat.
(but lacks clinically
above.
Analgesic: Site
and mechanism
of action unclear.
significant
antirheumatic and
anti-inflammatory
effects)
- Common cold, flu,
other viral and
bacterial infections
with pain and fever
- Unlabeled use:
Prophylactic for
children receiving DPT
vaccination to reduce
incidence of fever and
pain
CONTRAINDICATION
- Contraindicated with
allergy to acetaminophen
- Use cautiously with
impaired hepatic
function, chronic
alcoholism, pregnancy,
lactation
- Contraindicated in
pients with known
procainamide
hypersensitivity
- Caution is also
recommended in patients
with existing
hypertension or other
cardiac disease that may
be sensitive to
catecholamine release.
ADVERSE EFFECTS
CNS: Headache
GI: Hepatic toxicity and
failure, jaundice
GU: Acute kidney failure,
renal tubular necrosis
Hematologic:
Methemoglobinemiacyanosis: hemolytic
anemia-hematuria, anuria:
neutropenia, leukopenia,
pancytopenia,
thrombocytopenia,
hypoglycemia
Hypersensitivity: Rash,
fever
NURSING
RESPONSIBILITIES
- Monitor liver function
studies: may cause
hepatic toxicity at doses
>4g/day
- Monitor renal function
studies: albumin
indicates nephritis
- Monitor blood studies,
especially CBC and protime if patient is on longterm therapy
- Check I&O ratio:
dereasing output may
indicate renal failure.
- Assess for fever and
pain
- Assess hepatoxicity:
dark urine, clay-colored
stools
- Assess allergic
reactions: rash, urticaria
X. DRUG STUDY
DRUG NAME
Generic Name:
Trianon
Brand Name:
Sleep well
Classification:
Antihistamine
Dosage/
Frequency/
Timing/ Route:
0.3-10mg tab
daily at bedtime
PO
MECHANISM OF
ACTION
This medication
works by blocking
certain natural
substances
(histamine,
acetylcholine)
that your body
makes.
INDICATION
Helps relieve
allergy/cold
symptoms such
as watery eyes,
runny nose, and
sneezing.
CONTRAINDICATION
•
•
•
•
•
•
•
•
•
overactive thyroid
gland
increased pressure in
the eye
closed angle
glaucoma
high blood pressure
stenosing peptic ulcer
blockage of the
urinary bladder
enlarged prostate
an inability to
completely empty the
bladder
chronic idiopathic
constipation.
ADVERSE EFFECTS
CV: Hypotension
CNS: drowsiness,
headache, dizziness
NURSING
RESPONSIBILITIES
Instruct patient to take at
bedtime as directed.
Causes drowsiness.
Caution patient to avoid
GI: nausea: vomiting,
driving and other
abdominal cramps
activities requiring
alertness until response
- blurred vision, decreased to mediation is known.
coordiination, dry
mouth/nose/throat
Caution patient to avoid
concurrent use of alcohol
or other CNS
depressants.
XI. DISCHARGE PLANNING
Medication
 Continue for the medication as prescribed by the physician.
Exercise
 Client must minimize his actions after being discharge.
 Client must limit his action during first week being at home.
 Least movement can be helped and avoid difficult activities that
causes exhaustion.
 Breathing exercise can also help to get into relaxed state.
XI. DISCHARGE PLANNING
Health Teaching
Health teaching helps to focus on patient’s and
practice healthy lifestyle by encouraging the patient
to eat healthy foods that advised from the
physician. Manage to drink a lot of water to stay
hydrated. Get plenty of rest and enough sleep.
Take the medicine as prescribe and follow the
instructions from physician.
XI. DISCHARGE PLANNING
Outpatient Follow Up
Follow up after 1 week.
Seek for help if there are any problems
encountered.
Diet
Increase oral fluid intake and eat more nutritious
food.
XI. DISCHARGE PLANNING
Spiritual
Encourage the client to trust and ask for guidance
and give strength in the healing process and for
wellness. Advice the patient to maintain their
relationship with God and love Him for all their
hearts and believe in Him and His plans.