1. The client/caregiver can define leukemia.
   1. It is the rapid production of white blood cells, many of which are immature.
   2. The white blood cells, leukocytes, may invade and damage bone marrow, lymph nodes, spleen, kidneys, and other organs of the body.
   3. The disease can be acute or chronic.
      1. In acute leukemia, symptoms occur suddenly and progress rapidly.
      2. In chronic leukemia, symptoms appear gradually.
2. The client/caregiver can list factors that increase the risk of leukemia.
   1. Cancer therapy
   2. Exposure to high levels of radiation and other chemicals
   3. Genetic factors (Down syndrome is associated with increased risk of leukemia)
3. The client/caregiver can recognize signs and symptoms.
   1. Fatigue and weakness
   2. Fever and chills
   3. Frequent infections
   4. Signs of bleeding
      1. Bleeding into the skin causing discoloration
      2. Nose bleeds
      3. Small reddish-purple spots on the skin (petechiae)
   5. Loss of appetite or weight
   6. Swollen lymph nodes and enlarged liver and spleen
   7. Shortness of breath when physically active
   8. Excessive sweating (especially at night)
4. The client/caregiver can list measures to manage leukemia.
   1. Obtain adequate rest to decrease anemia. Pace activities with rest periods.
   2. .Prevent bleeding.
      1. Report first signs of bleeding such as bruising, petechiae, bleeding gums, and so forth.
      2. Follow safety measures to avoid cuts and hemorrhage (soft toothbrush, electric razor, etc.).
      3. Avoid aspirin, which may increase bleeding tendency.
      4. Avoid activities that increase the risk of injury or trauma.
   3. Prevent infection.
      1. Perform meticulous hygiene.
      2. Avoid large crowds and people with infections.
      3. Increase fluids to decrease the possibility of urinary tract infections.
      4. Provide good mouth care to decrease the possibility of mouth sores.
      5. All caretakers should wash hands thoroughly.
      6. Report early signs of infection.
      7. Avoid uncooked eggs, unpeeled fruit, and unwashed vegetables.
      8. Change filters in air conditioners and furnaces.
   4. Take medications as ordered.
   5. Obtain adequate nutrition.
      1. Use measures to increase intake (refer to the teaching guide “Alteration in nutrition: less than body requirements”).
      2. Eat bland, high-calorie, high-protein foods.
      3. Avoid alcohol, hot or spicy foods, and acidic beverages to prevent mouth ulcers.
      4. Discuss the resources for delivery or preparation of meals such as Meals on Wheels or home health aid.
   6. Provide comfort measures as needed such as analgesics, position changes, etc.
   7. Drink at least 2 to 3 liters per day of fluids.
   8. Avoid over-the-counter medications unless recommended by a physician.
      1. Keep follow-up appointments with a physician.
      2. Wear a Medic Alert bracelet.
   9. The client/caregiver can list possible treatments.
      1. Chemotherapy
      2. Immunotherapy (substances to bolster immune system)
      3. Kinase inhibitors or other drug therapies
      4. Radiation therapy
      5. Bone marrow transplant
      6. Stem cell transplant
   10. The client/caregiver can list possible complications.
       1. Hemorrhage
       2. Stroke or seizures
       3. Infection
       4. Kidney or liver failure

Resources

The Leukemia and Lymphoma Society
www.leukemia-lymphoma.org

National Marrow Donor Program
www.marrow.org

Support groups