I. Demographic Data: (2.

5 points)
- Patient initials: DA

- Age: 7yrs

- Sex: Male

- Date of birth: _14/3/2002

- Data of Admission: 23/3/2009

- Diagnosis: ACUT _LYMPHOID LUKEMIA

- Room No: 3/2

- Allergies: _Pt not c/o _allergy from food or medication_. Pt c/o season
allergy.

- Gestational Age: 41wk

II. Health History: (10 points)

Obstetric History
Mother is 28 yrs old, and she obstetric history is gravida 4, para 4 , abortion
0.
No complain of hypertention , diabetic , or any disorder during pregnancy.
The mother did not received in each obstetric any pre natal care . just in first
and last gravida at 35 wks received pre natal care to take tetanus vaccine .
All para NSVD .
The gestational age for all children is same , and is 41wk .

1. Birth History:
Child was delivered NSVD , at 41wks , and his weight 3000 gm , no any
complications during delivery , in good general condition of baby , no
complain from any problems after delivery .
The length of 3rd stage of labor is normal, and it is about 20 minutes, and the
delivery was at hebron hospital, and she stayed for 24 hrs with the baby for
observation, then she discharged together with baby after 1day
hospitalization.
The baby apgar score at first 1-5 minutes about 8/10.
The date of birth 14/3/2002 .
PKU test was done to the baby at 4 days after delivery .

2. Nutritional History:

 Breast Feeding
Child was on breast feeding for first 2wks of life, the mother was asked
about the cause of this, and she answered me the reason related to lack of
milk gradually , and this problem present with all her childrens .
After that I encourage mother for breast feeding and educate mother about it
is benefits . also encourage mother to visit gynecologist to know what is
problem.

 Bottle Feeding
The mother started bottle feeding for the child from 2wk till 18 month
Others

 SOLID FEEDING
The mother started to give pt solid food between 4 and 6 month , and she
concerned on special solid foods can child tolerated it , like boiled rice and
vegetables , brushed fruits, and she introduce gradually .

Past Medical History

The past medical history free , child no complain from any problem.

Present Medical History

 In 11/3/09 , and before diagnosing child about 10 days , pt start C/O
high fever , headache , flank pain , swelling under earlobe , {lymph
node }, and very painfull without redness.
 During this symptoms child visit the doctor with his family , and
doctor order to give pt antibiotic , and go to do lab test .
 After lab test results pt and his family visit doctor in clinic , and the
DR order to repeat CBC test with blood film, also pt kept in Hebron
Hospital 2days.
 In 23/3/09 pt was referred to Beit Jala Hospital , pediatric department
for future investigations .
 Bone marrow aspiration test done on same day of admission , CBC
and lab test done,.
 Pt started after result of lab test on setron drug 1Amp , vencristin
chemotherapy 1.5 gm, and adriamicin drug 30 mg in 23/3/09, and this
repeted given in 1/4/09 , and 11/4/09.
 Kidrolaze chemotherapy drug given to the pt every other day, till 8
doses .
 Also pt start to give antibiotic as protection from infection.

Chief Complaint
Pt c/o nausea and vomiting with epigastric pain , also c/o loss of
appitite and stomatitis according mother report .
Immunization: (2.5 points)
Age BCG Hep IPV OPV DPT DT dT measle MMR
B s
One day 
1 months   

2 months   

4 months  
6 months   
9 months 
12 months  
15 months 
6 years  

Psycho-emotional: (2.5 points)

Child look quiet and he didn’t refuse the new disease , active well , I didn’t
observe of depression ,and he is cooperative with disease , and his family
help pt to adaptation for changing of health.
His parants cooperative well with child and disease, and the mother said to
her child about changes in the body image like loss of hair, and the child
response is good, don’t refused changes and keep quiet mood toward disease
almost time but in another time pt look bad mood.
The parants psychoemotional state is good and in some time look
depression, and the mother try to adapt with her child disease.

Social Environment: (2.5 points)

The relationship between family member and pt very good .
The number of family member consist of 6 persons , and all of them lives in
extended family with his brothers and the grand father , the total family
member contain of 13 person .
The number of rooms for pt family in the house consist of 2 rooms , and not
enough for this family .
The economic state is moderate , and his mother answered about my
question , if the money enough or not , is enough .
The environment of house moderate in ventilation , and small ground around
the house..
This family keep in closed family system , and not open with our
environment .
Child live with his family in AL-FAWWAR village.
The level of education of his parents is 10th class.
No risk of environmental factors around his house, the wether in general
quiet, and the area is not industrial.

III. General appearance: (10 points)

Posture:
The posture child tall-straight well balanced.
When assess the pt muscles during rise his leg against my hand or when he
flex his , arm good flexibility and good muscles tone.
Muscles strength as well as palpation and pt can sitting and lying down
easily.

Position:
Child sleeps in many position and no special position for sleeping { in
some time sleep on RT side , or LT side , in another time pt sleep on his
back or his abdomen }.
The mother is pt was advice for the best sleeping position on side and back .
Also the mother educated the prone is risk for children because it effect on
respiration and make pressure on stomach.
The position pt during assessment on his back;

Personality
Child interact with his family members and environment , he is not
aggressive , child keep quiet before and after disease .
Pt easily interact with other childrens and try to speak with them.
 Behavior
Child is cooperative with medical members in hospital, and speak with
team , and interact during procedures in almost time .
In some times behaviors pt changed such as go to crying toward some kind
of procedure , like to kept pt NPO , and pt become hypoactive .
Also same reaction during bone marrow aspiration test done, and he refused
this test befor done, but after that he agree to do it.
Pt dose not refused the medication .

Speech
In general child is quiet .
When I try to speak with pt about different subject ,pt make to discuss with
me without refused that , and he have good speech language , also he have
good reduction sound and voice.

Facial expression:
Child look quiet , and happy when he goes to games .
In another times child look irritable and sad .
No any asymmetry or involuntary movement in facial expression.

Hygiene
Child is good general hygiene , washing hands , bathing every other day ,
and maintain oral hygiene.
Also mothers child make to maintain of food hygiene , and pt to take care
for himself with his mother.

State of Nutrition
Child complain of imbalanced nutrition due to less than body requirement ,
related to loss of appitite due epigastric pain and side effect of
chemotherapy.
Chemotherapy make to the pt nausea , vomiting , epigastric pain ,
stomatitis , and this cause loss of appitite to the pt.
In general child does not refuse any kind of eat , and he likes specially rice,
meat, and juice.
The mother encourage to give pt adequate fluid intake , and suggest smaller ,
more frequent meal , low salt diet , and encourage frequent oral hygiene .

Level of Activity
Child is active well in most time ,in moderate activity level , and play with
other children , in rare time seen hypoactive and lazy , walking in square
many time during day , and go to watching TV , most time out of bed if he
didn’t c/o pain or problems .

IV.Growth Measurements:
Growth Normal Range Comments

Ht: 130 cm 120 cm

Wt: 26 kg 21 kg
Hc: 51 cm 51 cm
CC: 56 cm 57 cm

V. Physical Assessment: (20 points)

SKIN
When I doing exam to the skin pt by palpation and inspection ,I work
to get hold of and grasp the skin ,my observation for the following :

1. skin targur : good skin targur when I grasp it , and skin return to its
normal position quickly without residual marks and good amount of
elasticity
2. color : my observation about the skin child color is pale, no cyanosis or
jaundis at the hand , lip foot was noted ,pink lip and nails in color .
Ecchymosis in some area { old canula place } due to extra vasation of blood
in to the skin because WBC in CBC IS low and the vessels easily to rupture
{ on the RT hand on elbow }.
Old small scar on the RT knee due to falling down the pt and crushing the
skin .
Redness color of skin and inflammation seen around anus area due to
pyrexia and chemotherapy

3. Temperature :
skin is warmth to touch , no cold or cyanosis
The temperature about 37c .

4. Texture
The skin is smooth and soft , no dryness or roughness.
Good skin integrity ,no odema was seen.
No dehydration or connective tissue disorder .
Good skin hygiene , no bad smell or odor.

Head a Neck
The head of the child is round in shape and symmetry ,good hygiene ,
no any scar ,odema , or protrusions .
The neck is good motility in each side, normal in size and long.
When inspect the trachea between my thumb and index, I didn’t palpate any
mass or lymph node .
The trachea is in the midline, and the thyroid gland is located at the base of
neck.
Also the carotid pulse is palpating and rythem

Hair: the hair is dark in color , very short . pt complain of loss of hair due to
falling down of hair because pt taken chemotherapy .
Mild dry in textur hair , mild quality .
Eyes : the eyes are black in color , symmetry , equal movement of the
pupils , round and equal .
The space between eyes normal and is about 4.5cm .
When do exam the eyes by ophthalmoscope , the pt eyes good reaction to the
light , and no any irregularities , good visual acuity when asked pt to read
some words .
The eye lids closed and open completely , no any infection or irritation
present , no edema or mobility and no signs of marginal blepharitis .
The sclera is white in color , no nodules or swelling .
The eyes brow symmetry , dark in color .
The conjunctiva pink in color , no inflammation.
Vasodilator occur to the pupils of eyes when assess the pupils by
opthalmoscope when remove the light , and vasoconstriction pupils occur
when apply the light.

Nose: The nose is symmetry , no deviation or polyps .

Child complains of slightly runny nose due to history of allergy to the
change of seasone .
The mucosa is pink in color , no inflammation and pt can enable to use our
sense of smelling.
The septum is equal , no nasal flaring.

Ears: When inspect of the external auditory structures and used otoscope to
examine internal ear observes the ear symmetry , the pinna is on a horisantal
level with outer canthus of eyes , not flattened , in good hygiene , no
inflammation was observed of tympanic membrane , or any drain of pus, no
lesion or deformity, and it is pink in color.
Hearing acuity :
I call the child from distance area, and the response of pt answer me well
after he hearing my voice and I was observe good hearing acuity

Mouth & Throat: The lips pink in color and symmetry , moisture, no any
cracking or ulcer .
The mucosa lining is pink in color , pt complain of stomatitis and teeth
decay due to chemotherapy. The mother was encouraged to give pt adequate
fluid intake , and suggest smaller , more frequent meal , low salt diet , and
encouraged frequent oral hygiene .
Good mouth hygiene , no bad odor .
The tonsilse : no evidence of pus , swelling , ulceration or tonsillar
enlargement .
The tongue : no hardening when palpate.

Chest & Lungs

The size of the chest measured by placing the tab around the rib cage
at the nipple line, and the measure is 56 cm
The size of the chest is appropriate to the head size.
The shape of the chest is transverse direction and symmetry .
The chest movement during inspection rise and fall together .
When auscaltation the lung sound by stethoscope , the sound clear, no
wheezes or crepitation, and no murmur heart sound was hearing.
The nipple location slightly lateral to mid clavicular line and between fourth
and fifth ribs.
The heart rate is regular and within normal rang
.

Heart & Circulation:

The heart rate about 120b/m, and presence of all peripheral pulse.
Saturation in room air about 97%.
The capillary refill time less than 2nd , and this observe by make pressure on
the index finger and the skin return quickly .
The respiration pt rate rhythm and whether the pt breathing is regular.
No wheezes in breath sound .
The respiration rate : 25
When auscaltation the lung sound by stethoscope , the sound clear, no
wheezes or crepitation, and no murmur heart sound was hearing

Abdomen
The abdominal shape normally and is cylindrical .
When assess the abdomen and inspection soft lax , no tenderness, mass, or
pain .
Good abdominal skin integrity , and umbilical hernia was appearance .
No localized abdominal distention .

G.I.T
The bowel sound was hearing by stethoscope and was available .
Child complain of nausea and big amount of vomiting , yellow in color
when asked the mother about vomiting .
Pt complain of nausea due to chemotherapy, and loss of appitite was
observed .
The habbite of deffication is every day pass stool brown in color and soft,
moderate in amount, no diarrhea or abdominal distention .

Genitalia
Anus : around the sphincter anus seen skin irritation and inflammation ,
redness in color due to pyrexia before 2day and chemotherapy .
The inguinal and femoral area normal, no any bluges or suggest a hernia.

Back & Extremities

The upper and lower extremity symmetry .
The length of both hands is equal and is 21 cm.
The length of both legs is equal and is 27 cm.
The number of both hand finger and both foot fingers completely and
symmetry , no syndactyly or polydactyl syndrome was seen.
Child is balanced well during walking .
The movement of extremity normal in each side { arm, hand, feet, joint and
muscles }, no any deformity or disorder .
During pt raise his leg against my hand or when flex his knee no any pain
with this movement .
The joints equal range of motion , no heat when palpate , no any tenderness
or swelling .
The muscles symmetry and has good tone .
The nail pink in color, cleanliness , smooth and symmetry .
The spine for alignment and shoulder , iliac crest, symmetry in position .
When assess the back of child I didnt observed any protrusions or
deformity

Neurological System "Reflexes in infants"

Mental status :
Child is fully conscious and oriented to the place , person, and time.
Pt alert , awake, aware of ones self and environment , no drowsiness.
No decrease in memory or less of contact with environment .
Pt good coordinate with medical team during procedures , and with other
child and family members.

Fine motor :
This exam done by ask pt to grasp pencil and he writes his name and plant
his house and he did that.
Has good fine motor skills.

Gross motor :
Pt able to draft his house and bus, and he can race and run.
Has good gross motor function.

Sensation :
Visual acuity : has good visual acuity when asked to read some words .
hearing acuity : has good hearing acuity when try to call him from distance
area and he response to me quickly.
Smelling acuity : pt can enable to use our sense of smelling.
Child can distinguish between cold and hot, and has good reflex when assess
by touch the skin pt by tip of pin and he withdrow his finger quickly.
Child also can distinguish between diffrensial tastes.

Lymph Nodes
No palpated any lymph nodes during assessment in the neck or all of our
body area and used distal part of my finger when assess.

VI.Lab Results: (5 points)

CBC test in 14/3/09
 Lab Normal Recommendatio
Results Range ns
WBC 9.6 4.1 – 10.9 Normal
LYMPH 1.6 0.6 – 4.1 Normal
GRAN 7.4 2 – 7.8 Normal
RBC 4.5 4.2 – 6.3 Normal
HB 12.4 12 -- 18 Normal
HCT 36.3 37 --51 Normal
MCV 80.1 80 -- 97 Normal
MCH 27 26 – 37 Normal
RDW 13.6 11.5 – 14.5 Normal
PLT 206 140 -- 440 Normal
CBC test in 6/4/09
Lab Normal Recommendatio
Results Range ns
WBC 2.9 4.1 – 10.9 Due to chemotherapy,
make to low of blood
count.
LYMPH 1.3 0.6 – 4.1 Normal
GRAN 1.5 2 – 7.8 Normal
RBC 4.8 4.2 – 6.3 Normal
HB 12.8 12 -- 18 Normal
HCT 36 37 --51 Normal
MCV 84 80 -- 97 Normal
MCH 29 26 – 37 Normal
RDW 14.9 11.5 – 14.5 Normal
PLT 187 140 -- 440 Normal
CBC test in 13/4/09
Lab Normal Recommendatio
Results Range ns
WBC 9.1 4.1 – 10.9 Normal
LYMPH 3.7 0.6 – 4.1 Normal
GRAN 5 2 – 7.8 Normal
RBC 4.3 4.2 – 6.3 Normal
HB 12.0 12 -- 18 Normal
HCT 34.8 37 --51 Normal
MCV 80.1 80 -- 97 Normal
MCH 27.6 26 – 37 Normal
RDW 13.9 11.5 – 14.5 Normal
PLT 153 140 -- 440 Normal

Lab Normal Recommendatio

Results Range ns
CRP negative 6/4/2009
PT 17.8 11 -- 15 23/3/09
PTT 22.5 25 -- 35 23/3/09
INR 1.06 23/3/09
ALP 161u/l 0 -- 270 24/3/09
AMAYLAZE 70 u/l 0 --100 24/3/09
AST 23 0 -- 40 24/3/09
CREATININ 0.1 mg/dl 0.7 –1.2 24/3/09
UREA 35 mg/dl 15 -- 45 24/3/09
T.BILLIRUBIN 0.7 mg/dl 0.0 -- 1 24/3/09
LDH 1028 <480 23/3/09.
Because the
lymphocyte rich with
LDH enzyme , and in
case of ALL
lymphocyte increase
rapidly , and already
LDH increase.
LDH 640 <480 14/4/29
BONE MARROW ASPIRATION :in 24/3/09
Lymphocytosis{140,000} R/O ALL
The result of bone marrow aspiration hemodiluted
aspiration in adequate, and the hematologist doctor ask if
he want to repet aspiration, he answer the pt no need to
repet test because the lymplocyts in the blood film more
than 150,000.
Medications: (10 points)

Name of
Route Dose Action Side Effect
Drug
Aderiamycin IV 30 mg antineoplasmic chemotherapy drug, 1.nausea and vomiting
3 doses for work by damaging DNA and RNA, 2.low blood counts,
3week. that tells the cell how to copy it self WBC,RBC,PLT, may
in division. If the cells are unable to temporarily decrease
divide they die. The faster cells are 3.mouth sores and
dividing, the more likely it is that stomatitis.
chemotherapy will kill the cells, 4.loss of hair.
causing the tumor to shrink. 5.changein color of
urine may appear red
or orange.
Kidrolase IV / IM 7000 unit . Chemotherapy drug anticancer, this 1.fever
Other name 8 doses for medication classified as an enzyme. 2.nausea and vomiting
Asparaginase every other All cells need a chemical called 3.stomach cramping
day. asparagines to stay alive, normally 4.poor appetite
cell can make this chemical for 5.allergic reaction like,
themselves, while cancer cells itching, rash, and face
cannot, asparagines break down swelling .
asparagine , they die.
Vincristine IV 1.5gm Chemotherapy drug, anticancer, 1.hair loss
3 doses for classified as a plant alkaloid. drug, 2.nausea and vomiting
3week work by damaging DNA and RNA, 3.constipation
that tells the cell how to copy it self 4.low blood count
 in division. If the cells are unable to 5.weight loss
divide they die. The faster cells are 6.stomatitis
dividing, the more likely it is that
chemotherapy will kill the cells,
causing the tumor to shrink.
Rocephin IV /IM 500mg twice It work by fighting bacterial in body 1.diarrhea that watery
Other name daily IV {antibiotic } or bloody
ceftriaxone It work to inhibetor the protein 2.fever or chills
synthesis or cell wall. 3.skin rash
Nausea and vomiting
4.headache and
dizziness
Gentamycin IV diluted or 40mg twice It is active against some gram 1.difficulty hearing
Other name IM daily IV positive and money gram negative 2.dizziness
Aminoglycoside organisms , like E. coli , klebsiella , 3.increased thirst
Antibiotic pseudomonas, and treat serious 4.pain or difficulty
infection caused by this bacteria passing urine .
Hydrocortisone IV 50mg twice Hydrocortison prevents the release 1.swelling rapid weight
daily of substance in the body that cause gain, feeling short of
inflammation . used to treat many breathing.
different conditions such as allergic 2.problem with vision
disorder, skin conditions, or 3.sleep problem.
breathing disorders 4.dry skin, acne
5.slow wound healing
ZOFRAN IV 32mg Zofran used to prevent nausea and 1. blurred vision.
{SETRON} vomiting that caused by surgery or 2.slow heart rate.
 by medicine to treat cancer 3.anxiety and agitation.
{chemotherapy or radiation}, given 4. Shivering.
before 30minutes of chemotherapy.
RATIDINE IV 25mg twice Is group of drug called a histamine - 1.chest pain, fever.
daily 2bllocker. Work by reducing the 2.unusual weakness.
amount of acid in stomach produces 3.fast or slow heart rate
Use to prevent ulcer in the stomach 4.problems vision.
and intestines.
ZYLORIC TAB 1/2 tab 3 time Zyloric tab belong to a group of 1.high fever.
daily. 100mg medicines called enzyme inhibitors, 2.joint pain.
which act to control the speed at 3.nausea and vomiting.
which special chemical changes 4.jaundice.
occure in the body. They are used to 5.chest pain, high
prevent gout and other conditions blood pressure.
associated with excess uric acid in 6.feeling thirst, tired,
the body ,including kidney stones and losing weight.
and certain types of kidney diseases.
VIII. Pathophysiology of the disease: (10 points)

Definition:
Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and
bone marrow — the spongy tissue inside bones where blood cells are made.

The disease progresses rapidly and affects immature lymphocytes blood

cells, rather than mature ones.. Acute lymphocytic leukemia is also known
as acute lymphoblastic leukemia and acute childhood leukemia.

Acute lymphocytic leukemia is the most common type of cancer in children..

Pathophysiology:
Bone marrow cell develops errors in its DNA. the errors tell the cell to
continue growing and dividing rapidly blood cell production goes awry.
The bone marrow produces immature cells that develop into leukemic white
blood cells called lymphoblasts. These abnormal cells are unable to function
properly, and they can build up and crowd out healthy cells.

S+S:
Signs and symptoms of acute lymphocytic leukemia may include:
 Bleeding from the gums
 Fever
 Frequent infections
 Frequent or severe nosebleeds
 Loss of appetite
 Lumps caused by swollen lymph nodes in and around the neck,
underarm, stomach or groin
 Pale skin
 Shortness of breath
 Weight loss
 Weakness, fatigue or a general decrease in energy

Medical Treatment: In general, treatment for acute lymphocytic leukemia

falls into separate phases:
 Induction therapy. The purpose of the first phase of treatment is to
kill most of the leukemia cells in the blood and bone marrow.
 Consolidation therapy. Also called post-remission therapy, this
phase of treatment is aimed at destroying the leukemia cells
remaining in the brain or spinal cord.
 Maintenance therapy. The third phase of treatment prevents
leukemia cells from regrowing. The treatments used in this stage are
often given at much lower doses.
 Preventive treatment to the spinal cord. People with acute
lymphocytic leukemia may also receive treatment to kill leukemia
cells hiding in the central nervous system during each phase of
therapy. In this type of treatment, chemotherapy drugs are injected
directly into the fluid that covers the spinal cord. This kills cancer
cells that can't be reached by chemotherapy drugs given by mouth or
through an intravenous line.

 Radiation therapy. Radiation therapy uses high-powered beams,

such as X-rays, to kill cancer cells. If the cancer cells have spread to
the central nervous system, doctor may recommend radiation
therapy.
 Bone marrow stem cell transplant. A bone marrow stem cell

transplant may be used as consolidation therapy in people at high

risk of relapse or for treating relapse when it occurs. This procedure
allows someone with leukemia to re-establish healthy stem cells by
replacing leukemic bone marrow with leukemia-free marrow.

A bone marrow stem cell transplant begins with high doses of

chemotherapy or radiation to destroy any leukemia-producing bone
marrow. The marrow is then replaced by bone marrow from a
compatible donor (allogeneic transplant). In some cases, people are
able to use their own bone marrow for transplantation (autologous
transplant). This may be possible if child goes into remission and
healthy bone marrow is then harvested for a future transplant.
Complications
: The list of complications that have been mentioned in various sources for Acute lymphocytic leukemia includes:
Complications and sequelae of Acute lymphocytic leukemia from the Diseases Database include:
 Periosteal reaction
 Lymphadenopathy
 Red cell production reduced
 Immune deficiency
 Ferritin levels raised (serum)
 Eosinophilia
 Lymphocytosis
 Thrombocytopenia

IX. Nursing Care Plan: (20 points)

Ng. Diagnosis Ng. Intervention Rotational Evaluation

ALOPECIA. 1.discuss potential hair 1. provide information so 1.identify alopecia as potential
Goal: loss and regrowth with pt and family can begin to side effect of treatment.
Maintenance of pt and family. prepare cognitively and 2. use mild shampoo and
tissue integrity, 2.prevent to minimize emotional for loss. conditioner and shampoo hair only
coping with hair hair loss through the 2. preserve tissue when necessary.
loss. following: integrity. 3. maintain hygiene and grooming.
a. cut long hair before a. assists in maintaining 4. interact and socialize with
treatment. skin integrity. others.
b. use mild shampoo b. prevents ultraviolet
and conditioner, gently light exposure.
pat dry , and avoid 3. reassures pt that hair
excessive shampooing. loss is usually temporary.
3.Explain that hair
growth usually begins
again once therapy is
completed.
NAUSEA AND 1. assess the pt previous 1. unpleasant sensations  Reports decrease in
VOMITING experience and can stimulate the nausea incidence of vomiting.
Goal: expectations of nausea and vomiting.  Consumes adequate fluid
Fewer episodes of and vomiting , including 2. administration and food when nausea
nausea and vomiting causes and interventions antiemetics regimen subsides.
before, during, and used. before onset of nausea and  Demonstrates use of
after chemotherapy. 2. prevent unpleasant vomiting limits the distraction relaxation, and
sights, odors, and sound adverse experience and imagery when indicated.
in environment. facilitates control.  Exhibits normal skin turgor
3. administer prescribed 3. adequate fluid volume and moist mucous
antiemetics, sedatives, dilutes drug levels, membranes.
and corticosteroid decreasing stimulation of
before chemotherapy vomiting receptors.
and afterward as 4. each pt responds
needed. differently to food after
4. ensure adequate fluid chemotherapy. A diet
hydration before, containing foods that
during, and after drug relive the pt nausea or
administration, assess vomiting is most helpful.
intake and output.
DISTURBED 1. assess pt feeling 1. provide baseline 1. participates in self-care
BODY IMAGE about body image and assessment for evaluating activities.
Goal: level of self-esteem. changes and assessing 2. permite others to assist in care
Improved body 2. identify potential effectiveness of when he unable to be independent.
image and self- threats to pt self-esteem interventions. 3. participate with others in
esteem. {eg, altered appearance, 2. prevents or reduce conversations and social events
hair loss, decreased depersonalization and and activities .
energy}. emphasize pt self-worth. 4. verbalizes feeling reactions to
3. individualize care for 3. physical well-being losses or threatened losses.
the pt. improves self-esteem.
4. assist pt in self-care 4. promotes positive body
 when fatigue, lethargy, image.
nausea, vomiting, and
others symptom prevent
independence.
Risk for infection 1. assess patient for 1. signs and symptoms 1. demonstrates normal
related to altered evidence of of infection may be temperature and vital signs.
immunologic infectio. diminished in the 2. exhibits absence of signs of
response. 2. obtain cultures immunocompromis inflammation: local edema,
Gool: and sensitivities ed host. Prompt erythema, pain, and warmth.
Prevention of as indicated recognition of 3. exhibits normal breath
invection before initiation infection and sounds on auscultation.
of antimicrobial subsequent 4. avoid contact with others
treatment (wound initiation of therapy with infections.
exudates, sputum, will reduce 5. adheres to dietary and
urine, stool, morbidity and environmental restrictions.
blood). mortality associated
3. instruct all with infection.
personnel in early detection of
careful hand infection facilitates early
hygiene before intervention
and after entering
room.
avoid rectal or vaginal
procedures ( rectal
temperatures,
examinations,
 suppositories, vaginal
tampons).
Imbalanced 1. teach patient to 1. anorexia can be 1. exhibits weight loss no
nutrition: less than avoid unpleasant stimulated or greater than 10% of
body requirements, sights, ordors, increased with pretreatment weight.
related to anorexia, sounds in the noxious stimuli. 2. demonstrates normal skin
cachexia, or environment 2. smaller, more turgor.
malabsorption during mealtime. frequent meals are 3. consumes diet high in
Gool: 2. encourage better tolerated required nutrients.
Maintenance of adequate fluid because early reports that pain does not
nutritional status intake, but limit satiety does not interfere with meals}
and of weight fluids at occur.
within 10% of mealtime. 3. a quiet environment
pretreatment weigh 3. suggest smaller, promotes
more frequent relaxation. Social
meals. interaction
encourage frequent interaction at
oral hygience mealtime increases
appetite.
oral hygiene stimulates
appetite and increases
saliva production
Organization, Spelling, and neatness:(5points}