CHAPTER I

BACKGROUND OF THE STUDY

Introduction

Leukemias are cancers of the white blood cells, which begin in the bone

marrow. This complex set of diseases is grouped in two ways: by the type of

white blood cell affected—either lymphoid or myeloid—and by the pace at

which the disease progresses. Lymphocytic leukemia develops in the white

blood cells called lymphocytes in the bone marrow, and Myeloid leukemia may

also start in white blood cells other than lymphocytes, as well as red blood cells

and platelets. In terms of how quickly it develops or gets worse, leukemia is

classified as either acute or chronic, Acute appears suddenly and grows quickly

while chronic leukemia appears gradually and develops slowly over months to

years. This information refers to four types of leukemia: acute lymphoblastic

leukemia (ALL) which has rapid onset and progression and is more common in

children accounting for up to 80% of cases versus 20% of cases in adults,

Chronic lymphocytic leukemia (CLL) usually slow-growing leukemia, acute

myeloid leukemia (AML) characterized by greater than 20% myeloid blasts and

is the most common acute leukemia in adults, and chronic myeloid leukemia

(CML) common in adults, nearly 50% of cases occur in the people over age 64

years. (Besa, n.d.-b)

Among the four types of Leukemia, acute myeloid leukemia is the most

aggressive cancer with a variable prognosis depending upon the molecular

1
subtypes. According to the American Cancer Society, the estimates for leukemia

in the United States for 2023 are About 20,380 new cases of acute myeloid

leukemia (AML). Most will be in adults, About 11,310 deaths from AML, it is

fairly rare overall, accounting for only about 1% of all cancers. AML is

generally a disease of older people and is uncommon before the age of 45. The

average age of people when they are first diagnosed with AML is about 68. In

the Philippines Leukemia is among the top five killer cancers in the country, as

of “2015 Philippine Cancer Facts and estimates” stated, around 4, 270 new cases

were diagnosed for the year, plus 3,386 leukemia-cased deaths in 2015. however,

there are no specific estimated statistics for Acute myeloid over the past year

and as of now.

When people have AML, blasts make copies of themselves quickly. This

slows the production of red blood cells and platelets, white blood cells, causing

tiredness from anemia, and a risk of bleeding from a low platelet count. (Acute

Myeloid Leukemia (AML), n.d.). People with leukemia are more likely to

develop anemia. This could be because leukemia, a form of blood cancer, causes

anemia, which involves a reduction in red blood cells or a reduced level of

hemoglobin, or both. It is not a disease but rather a manifestation of a disease

process or alteration in body function. (Rees, 2021c).

Individuals experiencing anemia often display nonspecific symptoms like

fatigue, weakness, and weariness. In cases of severe anemia, patients may

exhibit fainting, difficulty breathing, and a decreased ability to engage in

physical activities. (Turner, 2023).

2
 Although Leukemia is considered a genetic disease, most cases are not

thought to be hereditary. Instead a variety of risk factors can make to more likely

to get the disease.(Purdie, 2017). One of exposure attributable risk factor

analyses of acute myeloid leukemia according to Yi et al. (2020), includes

occupational exposure to benzene, and formaldehyde. Interestingly, the

contribution ratio of exposure to carcinogens significantly increased in regions

with a low social-demographic index (SDI) in contrast to those with a high SDI.

High level to long-term exposure to benzene content such as forest fires or

burning coal and oil, paint, detergents, industrial cleaning, and degreasing

formulations, and emissions from motor vehicle exhaust (The Impact of

Revising the Benzene Threshold Exposure Limit -- Occupational Health &

Safety, 2022)

Commonly, low levels of benzene won't be harmful, however, food can

also be contaminated with benzene, mostly can be found in processed food

containing ascorbic acid (vitamin C) and benzoates. Citrus juice-based

beverages are usually more contaminated with benzene than other beverages.

Benzene was also detected in carbonated beverages, fruit juices, pickles, and

lime juices. Smoked and canned products have a higher content of benzene

(Sadighara et al., 2022). Another causative exposure factor includes high levels

of exposure to Formaldehyde ( a colorless flammable gas at room temperature

that has a strong odor). It can be found in household products such as permanent

press fabrics, paints, and coatings, preservatives in some medicines, cosmetics,

Fertilizers, and pesticides. (Facts About Formaldehyde | US EPA, 2023).

3
 The team selected this case with the aim of enhancing comprehension

regarding the appropriate care for patients experiencing this particular medical

condition. Among the cases encountered by the team, this particular case

necessitates distinctive care, prompting the team to undertake further study.

4
 OBJECTIVES OF THE STUDY

At the end of the presentation the researcher will be able to:

Knowledge

 Discuss the pathophysiology of Acute Myeloid Leukemia

 Explain the nursing management of Acute Myeloid Leukemia and severe

anemia

 Identify the precipitating and predisposing factors of Myeloid Leukemia

AML and severe anemia

Skills

 Formulate a comprehensive nursing care plan for a patient with Myeloid

Leukemia utilizing the nursing process

 Study the drugs for patients with Acute Myeloid Leukemia

 Obtain nursing history for patients with Myeloid Leukemia

Attitude

 Observe and maintain the Value God’s guidance related to the case

presentation and of a patient with Acute Myeloid Leukemia

 Display patient’s confidentiality.

 Appreciate the value of honesty and accuracy in documenting and

reporting data of the patient..

5
 DEMOGRAPHIC DATA

NAME : Mrs. White

DATE OF BIRTH : August 23, 1964
AGE : 59 years old
GENDER : Female
MARITAL STATUS : Married
HOME ADDRESS : Naoway
RELIGION : Catholic
NATIONALITY : Filipino
EMPLOYMENT STATUS : House wife
ATTENDING PHYSICIAN : Larnie L. Vencer
DATE OF ADMISSION : September 18, 2023
CHIEF COMPLAINT : Body malaise and Ecchymosis
FINAL DIAGNOSIS : Acute myelogenous leaukemia severe anemia
secondary

6
 HEALTH HISTORY

I. CHIEF COMPLAINT

Fever, Body malaise and Ecchymosis

II. HISTORY OF PRESENT ILLNESS

Mrs. White is a 59-years-old female who experienced the symptoms three

weeks ago before admission to CLMRS. She undergoes consultation after worrying

about the duration of her condition. She was recently admitted at CLMRS hospital

last March 20, 2023, to March 27, 2023, due to pallor, body malaise and

ecchymosis on the upper extremities.

A bone marrow biopsy was done and revealed patient has Acute

lymphoblastic leukemia secondary mark of depression of normal hematopoiesis.

The patient was advised to undergo chemotherapy, however, due to financial

constraints and hopelessness, the patient did not comply Physician's advice but

rather stayed at home and rested. After Knowing the Diagnosis, Mrs White became

more food conscious and eliminated some of her diet such as eating processed foods

and drinking soft drinks. After being discharged, Mrs White spends more time with

her family and is limited to household work and and no longer encourage to help

her husband on their farm. The only medication Mrs white is taking is vitamin B

complex and her anti-hypertensive maintenance Amlodipine.

Six months Prior to Admission to Adventist Medical Center Bacolod, the

patient’s condition was deteriorating, as she experienced continuous and more

bruises in her upper and lower extremities, as well as feeling of body weakness and

7
 easily getting tired. She lose weight due to lost due to a loss of of appetite.

III. PAST MEDICAL HISTORY

A. MEDICAL ILLNESS

1. Childhood Illnesses: fever, common coughs, and colds

2. Adult Illness: Hypertension Diagnosed 2017
Acute Lymphoblastic Leukemia March 20, 2023

B.PSYCHIATRIC ILLNESS: None

C. SURGICAL PROCEDURES:Specimen Bone Marrow biopsy March 27, 2023

D.ACCIDENTS/ TRAUMA/INJURIES: No history accidents, traumas, and injuries

E. PAST HOSPITALIZATION: Acute Lymphoblastic Leukemia (ALL) March 20,

2023

F. IMMUNIZATION: Not Vaccinated of Anti Covid-19 and Hepa B vaccine, No

newborn immunization

G. ALLERGIES: None

H. MEDICATION: Amlodipine (maintenance), Folic Acid

I. EXPOSURE TO ENVIRONMENTAL HAZARDS: Exposed to pesticides while

working alongside with her husband for a continuous period of five years.

J. BLOOD TRANSFUSION-1 unit of of Packet red Blood cell (March 23, 2023)

2 units of of Packet red Blood cell (March 24, 2023)

2 units of Packet red Blood cell (September 19,2023)
2 units of Packet red Blood cell (September 20, 2023)
2 units of Packet red Blood cell (September 21,2023)
2 units of Platelet (September 23,2023)
2 units of Blood transfusion #4 (September 23,2023)
2 units of Blood transfusion #5 (September 23,2023)
2 units of Platelets (September 21,2023)
2 units of Blood transfusion (September 23,2023)

8
 GORDON’S FUNCTIONAL HEALTH
PATTERN

BEFORE HOSPITALIZATION DURING

HOSPITALIZATION
Health Before being diagnosed of The patient has set
Perception- Leukemia the patient believed she her mind to be discharged after one
Health is healthy, since she’s a little bit week of hospitalization. The patient
Management conscious with food. After being is willing to accept and listen to
diagnosed with leukemia the patient health teaching and shows interest to
refuse to undergo therapy, because recover easily, she adheres to all
she believe she will die apparently medication instructions provided by
“ luya na akon lawas, di ko nana the healthcare team.
kaya, mapatay man ko gihapon”
The patient is experiencing Body
weakness without fever and
ecchymosis. This condition worried
the family and they decided to
bring her to the hospital, however
the patient is worried to be
hospitalized due to finances
Nutritional- Prior to being diagnosed with In the first shift, Mrs. White
Metabolic leukemia, the patient’s typical diet expressed a loss of appetite and
includes vegetables, fruits, and fish. declined to eat, citing nausea as the
Yet, in the absence of accessible reason. She drinks water very often
food, they resort to consume canned and can only take 350ml in a day and
goods and noodles three times a 500ml IV infusion with the total of
week for convenient cooking. She 850ml . The Physician ordered LFLS
loves to eat grilled fish. She drank (Low fat low sodium).
powdered juices such as Tang every During second shift, the patient was
after lunch. And also, consumes advised NPO means nothing by

9
 softdrink twice a week. The patient mouth due to episodes of vomiting
has no allergies to food and drugs. with blood
Following the leukemia diagnosis, Streaks (Hematemesis).
she refrains from consuming non-
nutritious foods and instead includes
a regular intake of vegetables and
fruits in her diet.She drinks 7-8
glasses (1600-1800ml). The patient is
also taking folic acid as
vitamins/supplements. She can finish
1 cup of rice every meal and 1 serve
of viands.
Elimination Patient usually voids 2-3 times a
In the initial shift, Mrs. White
Pattern
day and defecates twice a day, she
had no urine output, prompting a
doesn’t experience any problem in
referral to the staff nurse. In the
voiding or in defecating and has
subsequent shift, her urine
never utilized any laxatives and
output measured 300, and it
stool softeners. showed the presence of blood
(hematuria).
Activity- The patient states that she does
The patient can only perform limited
Exercise some household chores such as
activities due to her condition, but she
Pattern cleaning their house, preparing
maintains independence when using
meals for her children and
the restroom.The motor strength from
gardening. She usually do some
upper and lower extremities is ++
walking for about 15-30 minutes
which signifies moderate weakness.
three times per week.

10
Sleep & Rest The patient usually sleeps 7-8 hours, The patient goes to bed at 8 pm and
Pattern her earliest time in going to sleep is rises at 5 am, getting 8-10 hours of
9pm and wakes up at 5am however, sleep. Additionally, she takes a 1-2
she is experiencing insomnia and hour nap around 2 pm in the
would tend to wake up in the middle afternoon. Despite the extended
of sleep and unable to go back to sleep duration, the patient still
sleep. But despite of experiencing experiences a sense of unrest.
insomnia, she doesn’t uses any
medication to promote
sleep.
Sexuality- The patient is doing self- breast The patient has a good intimacy
Reproductive examination every month. The relationship with her husband and
Pattern patient had her first menstruation at she is contented how understanding
the age of 14. At the age of 48, the her husband especially of her
patient experienced menopausal signs condition.
& symptoms. The patient stated that
she and her husband is no longer
sexually active due to her condition.
Cognitive- The patient is oriented to time, The patient is oriented to time and
Perceptual place and people. She can speak place. She doesn’t wear any glasses
and understand Ilonggo, Tagalog. nor experiencing blurring. The
She can responds to stimuli verbally patient is also experiencing pain in
and physically. abdomen below the navel and with
pain
scale of 8/10.

11
Role The patient is living with her The patient is well-supported by her
Relationship
husband and children, she stated family especially her 2 daughters
that they really spend time with who is taking care of her during the
each other and maintains the good hospitalization.
communication even if her eldest
daughter is currently away from
home.
Coping- The patient copes up to stress by The patient takes a nap and rest
Stress watching TV, doing household when tired. She spends her time
Tolerance chores and gardening. The patient’s with her daughter to ease her
blood pressure is elevated when emotions regarding her condition.
experiencing stressful situations. She desires to recover and relieved
from the body weakness, she
cooperates with the medical advice
of the
doctor and nurses.
Recreational Patient used to do household chores Due to hospitalization Mrs white’s
and watch television, she also enjoy leisure is only watching TV, taking
accompanying her husband in their with family members through phone
farm and spray pesticides for their or talking to her
plants. daughter.

Value-Beliefs The patients religious affiliation is The most important thing to the
Pattern Roman Catholic, she goes to church patient is her family and children.
with her family every Sunday. Despite of the patient’s condition,
When she has opportunity to go to her relationship to God remained
his favorite place, she wants to go to unchanged.
Simala
Church, Cebu.

12
FAMILY GENOGRAM

13
 CHAPTER II

THE DISEASE ENTITY

This chapter contains the disease entity which explores the anatomy and physiology,

pathophysiology, symptoms, and chief complain for a purpose of understanding the

condition of the patient being studied.

Chief Complaint: Body malaise, Ecchymosis, Fever

Medical Diagnosis: Acute myelogenous leukemia severe anemia secondary

Anatomy and Physiology of Leukemia

Circulatory System: Blood

Blood is one of the connective tissues. As a connective tissue, it consists of

cells and cell fragments (formed elements) suspended in an inter cellular matrix

(plasma). Blood is the only liquid tissue in the body that measures about 5 liters in

the adult human and accounts for 8 percent of the body weight. The body consists of

metabolically active cells that need a continuous supply of nutrients and oxygen.

Metabolic waste products need to be removed from the cells to maintain a stable

cellular environment.

Blood is the primary transport medium that is responsible for meeting these

cellular demands. Blood cells are formed in the bone marrow, the soft, spongy center

of bones. New (immature) blood cells are called blasts. Some blasts stay in the

marrow to mature. Some travel to other parts of the body to mature. The activities of

the blood may be categorized as transportation, regulation, and protection. These

functional categories overlap and interact as the blood carries out its role in

14
providing suitable conditions for cellular functions. The transport functions includes

carrying oxygen and nutrients to the cells, transporting carbon dioxide and

nitrogenous wastes from the tissues to the lungs and kidneys where these wastes can

be removed from the body, carrying hormones from the endocrine glands to the

target tissues.

The regulation functions includes helping regulate body temperature by

removing heat from active areas, such as skeletal muscles, and transporting it to

other regions or to the skin where it can be dissipated, playing a significant role in

fluid and electrolyte balance because the salt sand plasma proteins contribute to the

osmotic pressure, functioning in pH regulation through the action of buffers in the

blood,

The protection functions includes preventing fluid loss through hemorrhage

when blood vessels are damaged due to its clotting mechanisms, helping (phagocytic

white-blood cells) to protect the body against microorganisms that cause disease by

engulfing and destroying the agent, protecting (antibodies in the plasma) protect

against disease by their reactions with offending agents. (Anatomy | SEER Training,

n.d.)

Composition of blood

When a sample of blood is spun in a centrifuge, the cells and cell fragments

are separated from the liquid intercellular matrix. Because the formed elements are

heavier than the liquid matrix, they are packed in the bottom of the tube by the

centrifugal force. The light yellow colored liquid on the top is the plasma, which

accounts for about 55 percent of the blood volume and red blood cells is called the

15
hematocrit, or packed cell volume (PCV). The white blood cells and platelets form a

thin white layer, called the “buffy coat, ”between plasma and red blood cells.

A. Plasma

The watery fluid portion of blood (90 percent water) in which the corpuscular

elements are suspended. It transports nutrients as well as wastes throughout the body.

Various compounds, including proteins, electrolytes, carbohydrates, minerals, and

fats, are dissolved in it.

B. Formed Elements

The formed elements are cells and cell fragments suspended in the plasma.

The three classes of formed elements are the erythrocytes (red blood cells),

leukocytes (white blood cells), and the thrombocytes (platelets).

Erythrocytes (red blood cells)

Erythrocytes, or red blood cells, are the most numerous of the formed

elements. Erythrocytes are tiny biconcave disks, thin in the middle and thicker

around the periphery. The shape provides a combination of flexibility for moving

through tiny capillaries with a maximum surface area for the diffusion of gases. The

primary function of erythrocytes is to transport oxygen and, to a lesser extent, carbon

dioxide

Leukocytes (white blood cells)

Leukocytes or white blood cells are generally larger than erythrocytes, but

they are fewer in number. Even though they are considered to be blood cells

leukocytes do most of their work in the tissues. They use the blood as a transport

16
medium. Some are phagocytic, others produce antibodies, some secrete histamine

and, heparin, and others neutralize histamine. Leukocytes are able to move through

the capillary walls into the tissue spaces, a process called diapedesis. In the tissue

spaces they provide a defense against organisms that cause disease and either

promote or inhibit inflammatory responses. There are two main groups of leukocytes

in the blood. The cells that develop granules in the cytoplasm are called granulocytes

and those that do not have granules are called agranulocytes. Neutrophils,

eosinophils, and basophils are granulocytes. Monocytes and lymphocytes are

agranulocytes.

Neutrophils, the most numerous leukocytes, are phagocytic and have light-colored

granules.

Eosinophils have granules and help counteract the effects of histamine.

Basophils secrete histamine and heparin and have blue granules. In the tissues,

they are called mastcells. Lymphocytes are agranulocytes that have a special role in

immune processes. Some attack bacteria directly; others produce

antibodies.Monocytes are the largest of the WBCs; when they migrate into the

tissues, they transform into macrophages with huge appetites; macrophages are very

important in fighting chronic infections.

Thrombocytes (platelets)

Thrombocytes, or platelets, are not complete cells, but are small fragments of

very large cells called megakaryocytes. Megakaryocytes develop from

hemocytoblasts in the red bone marrow. Thrombocytes become sticky and clump

together to form platelet plugs that close breaks and tears in blood vessels. They also

17
initiate the formation of blood clots. (Composition of the Blood | SEER Training,

n.d.)

Blood Cell Lineage

The production of formed elements, or blood cells, is called hemopoiesis.

Before birth, hemopoiesis occurs primarily in the liver and spleen, but some cells

develop in the thymus, lymph nodes, and red bone marrow. After birth, most

production is limited to red bone marrow in specific regions, but some white blood

cells are produced in lymphoid tissue. All types of formed elements develop from a

single cell type – stem cell (pleuripotential cells or hemocytoblasts). Seven different

cell lines, each controlled by a specific growth factor, develop from the

hemocytoblast.

When a stem cell divides, one of the “daughters” remains a stem cell and the

other becomes a precursor cell, either a lymphoid cell or a myeloid cell. These cells

continue to mature into various blood cell. Blood-related cancers, or leukemias, have

been shown to arise from a rare subset of cells that escape normal regulation and

drive the formation and growth of the tumor. The finding that these so-called cancer

stem cells, or leukemic stem cells (LSC), can be purified away from the other cells in

the tumor allows their precise analysis to identify candidate molecules and

regulatory pathways that play a role in progression, maintenance, and spreading of

leukemias. The analyses of the other, numerically dominant, cells in the tumor, while

also interesting, do not directly interrogate these key properties of malignancies.

Mouse models of human myeloproliferative disorder and acute myelogenous

leukemia have highlighted the remarkable conservation of disease mechanisms

18
between both species. They can now be used to identify the LSC for each type of

human leukemia and understand how they escape normal regulation and become

malignant. Given the clinical importance of LSC identification, the insights gained

through these approaches will quickly translate into clinical applications and lead to

improved treatments for human is order and acute myelogenous leukemia have

highlighted the remarkable conservation of disease mechanisms between both

species. They can now be used to identify the LSC for each type of human leukemia

and understand how they escape normal regulation and become malignant. Given the

clinical importance of LSC identification, the insights gained through these

approaches will quickly translate into clinical applications and lead to improved

treatments for human leukemias. (Blood Cell Lineage | SEER Training, n.d.)

Anatomy and Physiology of Anemia

Blood is a constantly circulating fluid providing the body with nutrition,

oxygen, and waste removal. Blood is mostly liquid, with numerous cells and proteins

suspended in it, making blood "thicker" than pure water. The average person has

about 5 liters(more than a gallon) of blood. A liquid called plasma makes up about

half of the content of blood. Plasma contains proteins that help blood to clot,

transport substances through the blood. Blood plasma also contains glucose and

other dissolved nutrients. About half of blood volume is composed of blood cells.

(Blood Bank Mauritius - All About Blood, n.d.)

Red blood cells

A scientific name for red blood cells is erythrocytes. They are formed in the

bone marrow and are created by a stem cell. Red cells are the most numerous of all

19
blood cells in the blood. They are produced at a rate of 4-5 billion every hour in an

adult human. It looks like a doughnut, but without a hole in the middle. Red cells are

7-8microns in diameter. Yet, they are the heaviest particles in the blood. After they

deliver the oxygen, the red blood cells pick up a waste product called carbon dioxide,

known as CO2. Then they make the return trip back to the lungs through the veins

where the CO2 can finally be released. The body eliminates carbon dioxide every

time we breathe out. Then, the red blood cells start the trip all over again. (Dezube,

2023)

Red blood cells contain hemoglobin, a protein that carries oxygen. Oxygen is

known as O2. Each time we take a breath in, we are inhaling oxygen in the air. The

role of red cells is to absorb oxygen through the little alveoli in your lungs and

deliver it to all the muscles, tissues and organs in your body. To do this, they travel

through large arteries and tiny capillaries. Sometimes the capillaries are so small, the

red cells have to squeeze and bend themselves in half to get through in order to

release their load of oxygen. (Pittman, 2011)

White blood cells

A scientific name for white blood cells is Leukocytes. White blood cells are

an important part of our body's immune system. Their role is to defend the body

against infection by germs.White blood cells are capable of passing through the

walls of capillaries (tiny blood vessels) in order to attack, kill and consume intruder

germs.There are many different kinds of white blood cells and each one has a very

specific job to do. There are lymphocyte T cells and lymphocyte B cells, monocytes,

and granulocytes. (What Are White Blood Cells? - Health Encyclopedia - University

20
of Rochester Medical Center, n.d.)

Granulocytes contain little granules in their cytoplasm, or cell matter.

Granulocytes can be identified even further as neutrophils, basophils and eosinophils.

Granulocytes recognize signals that enemy germs send out when they invade the

body.

Monocytes and lymphocytes do not contain any granules. But when

granulocytes detect an enemy germ, they and the monocytes find it and eat it. Then

the monocyte examines the bits of protein the germ was made of to see how it was

put together. Next, the monocyte calls on the lymphocyte T cell (or Helper T cell)

which learns to recognize what the germ looks like. The lymphocyte T cell then

engages the help of the lymphocyte B cell which makes a special weapon called an

antibody to use against the germ. The lymphocyte B cell produces copy after copy of

these antibody weapons. When the antibody weapon finds its target, the germ is

stunned, wounded and killed.

Platelets are sticky little pieces that help prevent bleeding and make the blood

clot when a cut is made. When a stem cell decides to make platelets, it turns into a

factory cell called a megakaryocyte. This is a very large cell with several nuclei. The

megakaryocyte never leaves the bone marrow, but it does produce many, many tiny

fragments. These fragments are actually the platelets, small pieces of cell material or

cytoplasm. Platelets do leave the bone marrow and circulate freely in the blood

stream. Normally, platelets look round and smooth, but when they get busy plugging

up cuts and wounds they become spiky and ragged around the edges. When an injury

occurs to a blood vessel wall, the platelets respond by literally throwing themselves

21
over the cut to form a temporary plug within minutes slowing the loss of blood. The

platelets also attract a protein found in plasma called fibrin and use it to form a dense

netting that traps red blood cells and quickly becomes a clot. (What Are Platelets? -

Health Encyclopedia - University of Rochester Medical Center, n.d.)

All of the blood cells in your body are mixed together in a slightly yellowish

liquid called Plasma. Plasma is mostly made up of water, but also contains proteins,

sugars and salt. In addition to carrying blood cells throughout the body, plasma also

carries hormones, nutrients and chemicals, such as iron. Plasma has the important

function of maintaining the pH of the blood at approximately 7.4.

Hemoglobin

Hemoglobin is an iron-containing protein within RBCs that binds to oxygen

in the lungs, forming oxyhemoglobin. This complex releases oxygen to tissues and

organs as blood circulates. In anemia, the concentration of hemoglobin is reduced,

leading to decreased oxygen-carrying capacity and potential tissue hypoxia (oxygen

deficiency). (The Editors of Encyclopaedia Britannica, 2023)

Iron Metabolism

Iron is an essential component of hemoglobin. Anemia is often associated

with an iron deficiency, which can result from inadequate dietary intake, impaired

absorption, or chronic blood loss. Iron is absorbed in the small intestine and stored in

the body, mainly in the liver. When iron levels are insufficient, the body may not

produce enough hemoglobin, leading to anemia.

Bone Marrow

The bone marrow is responsible for the production of blood cells, including

22
RBCs. In anemia, there may be a decreased production of RBCs or abnormalities in

their maturation. Certain diseases, such as aplastic anemia or myelodysplastic

syndromes, can affect the bone marrow's ability to produce an adequate number of

healthy blood cells.

Erythropoiesis

Erythropoiesis is the process of RBC production. It occurs in the bone

marrow and is regulated by the hormone erythropoietin, which is produced by the

kidneys in response to low oxygen levels. In anemia, there may be inadequate

production of erythropoietin or impaired response to it, affecting the production of

RBCs.

Theoretical Background Acute myelogenous leukemia severe anemia secondary.

There are several predisposing factors that may affect the patient and her

susceptible to the disease acute myeloid leukemia, upon history taking the patient

stated that they don’t have family history related to any blood disease such as

Leukemia although most of her relatives died with unknown cause and not been

diagnosed. Eske (2023b) stated that Leukmia is a genetic disease but not necessarily

inherited, People inherit DNA, but it can also change during gestation before birth or

during lifetime. The symptoms associated with AML, as outlined by Emadi and Law

(2023), fatigue, weakness, easy bruising or bleeding, frequent infections, weight loss,

and pale skin. These clinical manifestations align with the patient's presentation.

According to Vakiti (2023) the onset and progression of symptoms in Acute

Myeloid Leukemia (AML) can vary widely among individuals. The time frame from

23
the initial development of AML cells to the manifestation of noticeable symptoms is

generally not well-defined and can be influenced by various factors. In some cases,

AML may progress rapidly, leading to the emergence of symptoms within a few

weeks or even days. In other instances, the disease may develop more slowly, and

symptoms may take longer to become apparent. Additionally, the presence and

severity of symptoms can depend on factors such as the patient's age, overall health,

and specific characteristics of the leukemia cells.

Anemia is a common manifestation in individuals with Acute Myeloid

Leukemia (AML), The excessive proliferation of abnormal myeloid and monocytic

cells in the bone marrow can lead to the replacement of normal hematopoietic cells,

including erythrocyte precursors. This infiltration interferes with the normal

production of red blood cells, contributing to anemia. Another way is when blast

cells become dominant, which are immature and non-functional, in the bone marrow

can suppress the production of mature and functional red blood cells. This reduction

in effective erythropoiesis contributes to anemia. (Emadi & Law, 2023)

Acute Myeloid Leukemia

AML originates from myeloid cells, which are a type of blood cell that develops

into white blood cells, red blood cells, and platelets. These cells mature in the bone

marrow and are released into the bloodstream when fully developed. In AML, there

is an abnormal proliferation of myeloid cells, which leads to the accumulation of

immature cells in the bone marrow and bloodstream . ALL, on the other hand,

originates from lymphoid cells, which are a type of blood cell that develops into

white blood cells called lymphocytes. These cells also mature in the bone marrow

24
and are released into the bloodstream when fully developed.

Acute Lymphoblastic Leukemia

In ALL, there is an abnormal proliferation of lymphoid cells, which leads to

the accumulation of immature cells in the bone marrow and bloodstream (National

Cancer Institute, 2021). Clinical Presentations: The clinical presentations of AML

and ALL can vary widely, but some common symptoms include fatigue, fever,

weight loss, bone pain, and easy bruising or bleeding (National Cancer Institute,

2021). However, there are some differences in how these symptoms manifest in each

type of leukemia. In AML, patients may also experience shortness of breath due to

the accumulation of immature cells in the lungs. This is known as leukostasis

(National Cancer Institute, 2021). Additionally, AML is more commonly diagnosed

in older adults and is associated with a poorer prognosis than ALL (National Cancer

Institute, 2021). In ALL, patients may also experience lymph node enlargement due

to the accumulation of immature cells in these areas. This is known as

lymphadenopathy. ALL is more commonly diagnosed in children and young adults

and has a better prognosis than AML (National Cancer Institute, 2021). The

treatment for AML and ALL also varies based on the specific subtype of the disease.

Both types of leukemia are typically treated with chemotherapy, radiation therapy, or

stem cell transplantation. In ALL, chemotherapy is typically administered as a less

intensive regimen due to the lower risk associated with this type of leukemia. This

can result in fewer side effects than seen in AML patients Stem cell transplantation

may also be considered for patients with high-risk ALL or for those who do not

respond to initial treatment (National Cancer Institute, 2021).

25
 In conclusion, while both AML and ALL are types of blood cancer that

originate from abnormal proliferation of immature cells in the bone marrow and

bloodstream, they differ in their cellular origins and clinical presentations. The

treatment for each type of leukemia also varies based on the specific subtype of the

disease. It is important for healthcare providers to accurately diagnose and treat each

patient based on their individual presentation to achieve the best possible outcome.

(Vakiti, 2023)

26
Concept Map: Acute Myelogenous Leukemia Severe Anemia

27
28
 The disease entity starting somatic mutation frequency increases exponentially

with patient age Milholland, B. et al. (2015). Benzene and Formaldehyde

leukaemogenesis causing impaired DNA Repair abilities and dysfunctional tumor

suppressor and oncogenes which acts together with genotoxic effects to induce

leukaemogenesis. This changes alter normal hematopoietic growth and differentiation,

resulting in an accumulation of large numbers of abnormal, immature myeloid cells in the

bone marrow, which takes the space for other blood components (White blood cell, Red

blood cell, plateletes) leading to pantocytopenia. Accumulation of multiple blast in the

bone marrow spill into the blood can lead to high result of white blood cell as well as can

contribute to a situation where the cancer cells may secrete an excessive amount of

coagulation promoting cytokines. This secretion can disrupt the normal balance of the

body’s clotting system, potentially leading to hypercoagulable state or disseminated

intravascular coagulation. The rapid proliferation of cancerous myeloid cells in the bone

marrow can result in the release of a large number of leukemia cells into the bloodstream.

This hightend cell turnover may contribute to complication such as tumor lysis sydnrome

where the breakdown of cancer cells releases in the intracellular contents into the

bloodstream. These can be metabolized to uric acid leading to hyperuricemia. The

breakdown of cells in tumor lysis releases potassium into the bloodstream. While this

might seem counterintuitive, the intercellular to cellular shift of potassium coupled with

other factors like increase renal excretion, can lead to hypokalemia. The released

potassium may nit be immediately taken up by the cells or adequately eliminated by the

kidneys causing a decrease in blood potassium levels.

29
 CHAPTER III

THE MANAGEMENT

This chapter deals with presenting the medical and nursing

interventions applied. It includes the complete physical assessment of the

patient, diagnostic test results and its significance, drug study and the

discharge summary.

PHYSICAL EXAMINATION
General Appearance: Patient White is lying on bed, awake and responsive.
Vital signs: BP: 140/80mmHg RR: 25 O2sat: 90% HR: 109bpm TEMP: 37.4 ˚ C

General Assessment:
SYSTEM ASSESSMENT FINDINGS
NORMAL FINDINGS ABNORMAL FINDINGS
Skin, Hair & Nails Skin is normally free from Ecchymosis (flat bruises) left
lesion and senile. Skin arm upper and lower
turgor grade 1, T: 37.4oC extremities, pale nails.
warm to touch, Hair is
well distributed, no Temperature: 39 ˚ C (September
dryness. 18, 2023)
Nails are smooth, firm,
clean with translucent
color, no presence of
clubbing.
Head and Face Face is symmetrical, no
No abnormal findings
involuntary movements,
can move facial muscles at
will, no swelling, lesions,
scars and
tenderness.

30
Eyes Symmetrical in size and
Pale palpebral conjunctiva
position, no eyelids
drooping, no signs of
traumatic injury. PERRLA
Ears Ear canal is clear without
No abnormal findings
discharge. Hearing is intact
with good acuity. No
tenderness in helix &
tragus
Nose & Sinuses Symmetrical, no
No abnormal findings
discoloration, swelling and
tenderness, no
discharge/bleeding.
Mouth and Throat Pink mucosa, no Pale lips due to anemia. Red,
swollen gums.
discoloration, lesion,
nodules or swelling, tonsils
visible but not enlarged.
Neck No noticeable enlargement
No abnormal findings
of lymph nodes thyroid
glands. Speak clearly
without slurring.
Thorax and Lungs No pain upon palpation, no Tachypnea, Dyspnea
masses, swelling or Respiratory rate: 25
deformities. Oxygen saturation 90% with
5 liters per minute via nasal
cannula at room air.
Thorax and Lungs No pain upon palpation, no Tachypnea, Dyspnea
masses, swelling or Respiratory rate: 25
deformities. Oxygen saturation 90% with
5 liters per minute via nasal
cannula at room air.

31
Cardiovascular No extra sound heard, S1 is HR: 112 bpm,
louder at the base on
Capillary refill 5
2nd intercostal space
S2 is louder at the base on seconds.
5th intercostal space
Weak pulses Radial, Brachial,
Carotid pulse is palpable
dorsalis pedis
Abdomen Soft, symmetric, non-tender Hematemesis (Bright red blood
without distension, streak emesis)
no lesions or scars.

Urinary No distention and no bulge Hematuria

present to umbilical region. Urine output deficit
Bladder is not palpable. (+) Wee bag
Urine output: 12 ml/hr
150 ml in a day
Extremities Upper and lower are able to
perform range of motion, Limited range of motion
without tenderness or
deformity and edema.
Musculo-Skeletal Erect posture with good The motor strength from upper
balance and normal gait and lower extremities is ++
while walking. which signifies moderate
weakness.
Neurological Alert and oriented to
person, place, time with No abnormal findings
normal speech, no motor
deficits noted.

32
 Laboratory Test
NAME OF TEST SPECIMEN RATIONALE NORMAL VALUES TEST RESULT SIGNIFICANCE

Uric Acid Blood To measures the level Elevated uric acid levels, a
of uric acid in the condition known as
2.50 – 6.20mg/dL 7.3
urine. hyperuricemia, In context of
leukemia, when a large number of
cancer cells die rapidly in a short
period of time. When the cancer
cells die, they release uric acid
into the bloodstream
Na Sodium Blood To monitor for sodium 137.00-165.00mm/dL 139 Normal

imbalances
K Potassium Blood To monitor for 3.50- 5.10mml/L 2.9 Indicate hypokalemia
potassium imbalances

Calcium Blood To monitor for calcium 8.40-10.20mg/dL 8.0 Indicate hypocalcemia

imbalances

33
 Laboratory Test
NAME OF TEST SPECIMEN RATIONALE NORMAL TEST RESULT SIGNIFICANCE
Complete Blood count VALUES

Hematocrit To monitor the current level of Low volume of red blood cells in
blood components 0.36 – 0.51 L/L 0.18 the blood may result in low
oxygen and nutrient transport.

Red blood cell A low RBC count, also known as

anemia, can affect the body’s
3.60-4.69 2.10 ability to transport oxygen and
10^12/L nutrients around the
cardiovascular system.

Low Hemoglobin means your

Hemoglobin 120.0 – 170.0 g/L 60.0 body isn’t getting enough oxygen,
making you feel tired and weak.
Blood

White Blood cell 4.5 – 10.5 284.8 Indicate inflammation or infection

10^9/L

Platelet 150 – 450 10 Indicates Thrombocytopenia, risk

10^9/L for bleeding.

34
 Laboratory Test
NAME OF TEST SPECIMEN RATIONALE NORMAL TEST RESULT SIGNIFICANCE
VALUES
Differential Count

Lymphocytes Blood 18.00-48.00 0 Lymphoctopenia, risk for

infection

Monocytes 1.00–8.00 0 Body is risk for infection

Eosinophils 0-5 0 Normal

Basophils 0-1 0 Normal

Neutrophil
35-36 2 Neutropenia, Immune system is
weakened, making harder for the
body to fight infection
Polys
35-60 0 Granulocytopenia, reduces body
resistance to many infections.

35
 Laboratory Test

NAME OF SPECIMEN RATIONALE NORMAL TEST SIGNIFICANCE

TEST
VALUES RESULT
Blood Indices

MCV (Mean Corpuscular Volume) Blood 81.1 – 96.0 FL 85.7 Normal

The RBC
indices measure
MCH
(Mean Corpuscular Hemoglobin) the size, shape, 27.0 – 31.2 pg 28.6 Normal
and physical High MCH scores are
characteristics 31.8 – 35.4 g/dL 53.3
commonly a sign of
MCHC of the RBCs.
(Mean Corpuscular Hemoglobin Concentration) macrocytic anemia. This
Your doctor can
use RBC condition occurs when the
indices to help blood cells are too big,
diagnose the which can be a result of
cause of anemia
not having enough vitamin
B12 or folic acid in the
body.

MPV 11.5 – 14.5 15.9 An MPV result that's

(Mean Platelet Volume) % CV higher than normal may be
a sign of: Throm
bocytopenia, not having
enough platelets.

36
 Laboratory Test

NAME OF TEST SPECIMEN RATIONALE NORMAL VALUES TEST RESULT SIGNIFICANCE

To detect and manage a 7.00-17.00 mg/dL 15.4 Normal
Blood Urea Nitrogen Blood wide range of
(BUN) disorders, such as
urinary tract infections,
kidney disease and
diabetes.
To check kidney Normal
Creatine function. 0.52-1.04mg/dL 0.48

Serum glutamic To help assess the health Normal

pyruvic transferase of the liver. 0.00-35.00 U/L 17.4
alanine transaminase
S6PT (ALT)
Monitor conditions that Low sodium Indicates
Sodium (Na) affect the balance of 137.00-145.00 mm/lL hyponatremia, which means
fluids, electrolytes, and 135.00 your body needs sodium for
acidity in your body. fluid balance, blood pressure
control, as well as the nerves
and muscles.

Potassium (K) To monitor or diagnose 2.60 Low potassium indicates

conditions related to 3.50-5.10mml/L hypokalemia which resulted to
abnormal potassium excessive loss of essential
levels. mineral that is needed by all
tissues in the body through
urine, sweat or stool.

37
 Laboratory Test
NAME OF TEST SPECIMEN RATIONALE NORMAL VALUES TEST RESULT SIGNIFICANCE

D-dimer Blood A blood test that 0.0 - 0.5mg/L 4.24 Elevated D-dimer indicate that
checks for blood you have a blood clotting
clotting problems. condition

NAME OF TEST SPECIMEN RATIONALE NORMAL VALUES TEST SIGNIFICANCE

RESULT
Assesss the extrinsic Normal
Prothrombin Blood and common pathways 12.5 - 13.3 % 12.1
of coagulation.
Measures how long it Normal
Activity takes your blood to 70.0 - 100.0% 87.1
clot.
Measures the ratio of Elevated INR means your
INR (International Protrombin 0.90 - 1.1% 7.03 blood is clotting too slowly,
Normalize ration) and there is a risk of
bleeding.

38
 Diagnostic Test

Date: September 18,2023

Name Of Test: Peripheral Smear

Purpose: Used to examine your red and white blood cells and your platelets under a microscope.

Findings: Red cells are Normocytic, normochromic. WBC markedly increased & more than 90%
blast of Myeloid & monocytic lineage. Platelets are decreased in number.
Remarks: Compatible with Acute Myelogenous Leukemia FAB (French-American-British
classification) M4 & M5, Acute myelomonocytic leukemia and Acute monocytic
leukemia.

39
 Drug Study
GENERIC/ CLASSIFI INDICATION DOSAGE MECHANISM OF NURSING CONSIDERATION/ PATIENT’S RATIONALE
ACTION
TRADE NAME CATION TEACHING

Piperacillin - Antibiotic Treatment of 4.5g IV Piperacillin OBSERVATION:

Tazobactam combination bacterial inhibits bacterial 1. Regularly assess the patients clinical response to 1. To monitor improvements in
infections cell wall synthesis, piperacillin therapy symptoms such as fever, pain,
and tazobactam and other signs of infection
enhances
piperacillin's 2. Conduct appropriate microbiological tests 2. To determine the sensitivity of
activity by the causative bacteria to
inhibiting certain piperacillin
bacterial beta- 3. Monitor laboratory parameters such as CBC, renal
lactamases. function tests, and liver function tests
3. To detect any abnormalities or
MANAGEMENT: signs of adverse reactions.
1. Adjust the dosage in patients with impaired renal
function
1. To prevent drug accumulation
2.Administer for the prescribed duration and potential toxicity.

3. Obtain appropriate cultures before initiating 2. To prevent the development of

piperacillin therapy. antibiotic resistance.

3. To identify the causative

bacteria and determine its
sensitivity to the antibiotic.

40
 EDUCATION:
1. To ensure the medication is
1. Explain that therapeutic drug monitoring may be within the effective range.
performed. 2. To monitor progress, adjust
treatment if needed, and address
2. Stress the importance of attending follow up any concerns.
appointments with the healthcare provider
3. To avoid complications.
3. Provide guidance on what to do if a dose is
missed and when to take the next schedule dose.

41
 Drug Study

GENERIC/TRADE CLASSIFI INDICATION DOSAGE MECHANISM NURSING CONSIDERATION/ PATIENT’S RATIONALE

NAME CATION OF ACTION TEACHING

Folic Acid Vitamin Used to treat or 1 tablet Folic acid is OBSERVATION:

prevent folate twice essential for 1. Assess patients dietary habits
deficiency and daily (BID) DNA synthesis 1. To determine the intake

certain of folic acid-rich foods

and repair and
types of anemia plays a crucial 2. Keep an eye out for signs and symptoms of folic
2. Symptoms may warrant
role in the acid deficiency such as fatigue, weakness, pale skin,
further investigation and
formation of red SOB, and cognitive changes
intervention
blood cells.
3. To assess its adequacy.
3. Periodically measure blood levels of folic acid.

MANAGEMENT:
1. To determine the amount
1. Evaluate the individual’s dietary intake
of folic acid consumed
through food sources.
2. Emphasize the importance of folic acid
supplementation before conception and during early 2. To prevent neural tube
pregnancy defects in the developing
fetus
3. Address excessive alcohol consumption.
3. This can contribute to

42
 EDUCATION: folic acid deficiency.

1. Encourage to consume a balanced diet rich in folic

acid from natural sources.
1. To ensure consistent
supply of vital nutrient.
2. Warn against excessive alcohol consumption

2. It can deplete folic acid

3. Promote a healthy lifestyle including regular levels.
exercise and a balanced diet

3. For overall well-being.

43
 Drug Study
GENERIC/ CLASSIF INDICATION DOSAGE MECHANISM NURSING CONSIDERATION/ PATIENT’S RATIONALE
TRADE ICAT OF ACTION TEACHING
NAME ION
Hydrocortis Corticost Hydrocortiso 100g IV Hydrocortisone is a OBSERVATION:
one eroid ne is used to q8 corticosteroid used 1. To prevent further
treat certain for its anti- 11. Monitor signs of thrombophlebitis and complications.
medical inflammatory and thromboembolism. Notify physician or nursing staff
conditions immunosuppressive immediately, and request objective tests if thrombosis is
such as blood effects. Its anti- suspected.
or bone inflammatory 2. To ensure the amount of medicine
marrow action is due to the 2. Monitor and report signs of peptic ulcer, including is both safe and effective.
problems. suppression of heartburn, nausea, vomiting blood, tarry stools, and loss of
migration appetite.
of polymorph 3.Anaphylaxis can be life-
nuclear 33. Monitor signs of hypersensitivity reactions or threatening and requires
leukocytes and anaphylaxis, including pulmonary symptoms (tightness in immediate medical attention.
reversal the throat and chest, wheezing, cough, dyspnea) or skin
of increased reactions (rash, pruritus, urticaria). 1. To prevent medication errors
capillary and to avoid withdrawal
permeability. MANAGEMENT: symptoms when stopping the
medication.
1. Advise patient to take this drug exactly as prescribed.
Do not stop taking this drug without notifying your
2. To reduce side effects of stomach
health care provider; slowly taper dosage when
irritation, including indigestion,
discontinuing high-dose or long-term therapy.
stomach inflammation or ulcers

44
2. Advise patient to take with meals or snacks if GI upset
occurs.
3. Vaccine may not work as well
while you are taking steroids.

3. Do not give live virus vaccines with

1. Discontinuation can lead to a
immunosuppressive doses of hydrocortisone.
rebound effect and worsening of
symptoms.
EDUCATION:
1. Educate patient not to abruptly stop using hydrocortisone
2. To avoid increase risk of skin
without consulting health care provider.
irritation or interfere with the
action of hydrocortisone
2. Encourage to avoid alcohol and other other substance

3. To help maintain skin hydration

3. Encourage to use moisturizer alongside hydrocortisone
and improve the overall
effectiveness of the treatment.

45
 Drug Study
GENERIC/ CLASSIFICATION INDICATION DOSAGE MECHANISM OF NURSING RATIONALE
TRADE ACTION CONSIDERATION/
NAME PATIENT’S TEACHING
Hydroxyurea Antimetabolite Hydroxyurea treats 500mg 2 Hydroxyurea inhibits OBSERVATION:
cancer by slowing caps BID the formation of DNA 1. Assess signs of 1.This drug may promote further signs of
or by blocking an enzyme infection/fever, sore throat, infection/fever, sore throat, cough, difficult
stopping the growth known as cough, difficult or painful or painful urination of the patient as its side
of cancer cells in ribonucleotide urination. Effects.
your body. reductase. This results
Hydroxyurea treats in the decreased ability 2. This medication may
sickle cell anemia of the bone marrow to interfere with certain
by produce platelets. By 2. Monitor CBC with WBC lab tests, possibly
helping to prevent slowing down the Differential, platelet count. causing false test
formation of sickle- production of platelets Results. Make sure lab
shaped red blood in the bone marrow, personnel and all your
cells. hydroxyurea decreases doctors know you use
the number of platelets this drug.
in blood vessels. MANAGEMENT:
1. Regular monitoring is essential 1. To assess the effectiveness of hydroxyurea
and to detect any potential side effects or
complications.

2. Blood test may be performed

2. To monitor blood counts and other relevant
parameters.

46
 3. Manage side effects as needed. 3. To know when to adjust dosage or using
supportive care measures.

EDUCATION:
1. Avoid exposure to sunlight or 1. Hydroxyurea may cause other cancers
Tanning beds. (such as secondary leukemia, skin cancer).

2. Instruct patient to take 2. These side effects may occur that usually
medication as directed, even if do not need medical attention, it may go
nausea, vomiting, or diarrhea is away during treatment as body adjusts to
a problem. the medicine.

3. Encourage open communication 3. To address any concerns they may have

with patients about the medication.

47
 Drug Study
GENERIC/TRADE CLASSIFICATION INDICATION DOSAGE MECHANISM OF NURSING RATIONALE
NAME ACTION CONSIDERATION/
PATIENT’S TEACHING
Febuxostat Xanthine oxidase To lower Xanthine oxidase is OBSERVATION:
inhibitors hyperuricemia needed to oxidize 1. Regularly monitor serum 1. To assess drug
(high uric acid in successively uric acid levels effectiveness.
the blood). hypoxanthine and
xanthine to uric acid. 2. Monitor renal function 2. Febuxostat is
Thus, febuxostat regularly, especially in patients
primarily metabolized
with pre-existing renal
inhibits xanthine in the liver, but renal
impairment.
oxidase, thereby function should be
reducing production assessed due to the
of uric acid. potential for kidney-
related adverse
effects.

3. If any adverse
3. Watch for common adverse
effects, such as nausea, rash, effects are observed,

and liver abnormalities. appropriate

management strategies
or dosage adjustments
may be necessary.
MANAGEMENT:
1. Consider prophylactic 1. To manage these
measures or anti-inflammatory flares until uric acid
medications levels are adequately

48
 controlled.
2. Consider dose adjustments
based on individual patient 2. to achieve optimal
response and tolerance. uric acid control while
minimizing side
effects.
3. Schedule regular follow-
up appointments 3. to assess the
patient's response to
febuxostat, adjust the
treatment plan if
needed, and address
any concerns or
questions the patient
may have.
EDUCATION:
1. Instruct patient to report
1. Those could lead to
chest pain, rash, shortness of
serious problems
breath, or neurologic
without the help of
symptoms suggested of a
medical attention.
stroke.
2. Advise patients that drug
2. May be taken without
may be taken without regard
regards to food and
to meal
antacid use.

3. Advise patient that

3. May take with
concomitant prophylaxis with
NSAID's or colchisine to
49
 an NSAID or colchicine for prevent grout flares upon
gout flares may be starting therapy and with
used. mobilization of urate
from the tissues deposits.

50
 Drug Study
GENERIC/TRADE CLASSIFICATION INDICATION DOSAGE MECHANISM OF NURSING RATIONALE
NAME ACTION CONSIDERATION/
PATIENT’S TEACHING
Calcium tablet Calcium treatment of calcium 1 tab BID Essential element of OBSERVATION:
supplement deficiency, prevent body, helps maintain 1. Monitor for any adverse 1.As they may need to
hypocalcemia. functional integrity effects such as constipation, adjust the dosage or
of the nervous and bloating, gas, or stomach recommend a different
muscular system, upset. form of calcium.
helps maintain
cardiac function, 2. Monitor renal function 2. as excessive calcium
blood coagulation; is regularly, especially if taking intake can affect kidney
an enzyme co-factor higher doses of calcium function.
and affects secretory
activity of endocrine 3. Regularly assess your 3. Bone density scans
and exocrine glands. bone health, especially if may be recommended
calcium supplementation is periodically to evaluate
part of a treatment plan for the effectiveness of the
conditions like osteoporosis. supplementation.

MANAGEMENT: 1. The acid the stomach

1. Give calcium carbonate makes while eating helps
antacid 1 and 3 hr after meals the body absorb calcium
and at bed time. carbonate and Bone
resorption follows a
circadian rhythm that

51
 peaks at night.

2. Calcium might
2. Do not give 1-2 hr. of other decrease how well
medications if possible. some antibiotics work

3. .Provides valuable
3. Advise patient to notify information about
health care professional whether any
promptly if signs and medications are
symptoms of hypercalcemia working as intended or
(constipation, anorexia, nausea, need to be adjusted.
vomiting. confusion, stupor)
occur.

EDUCATION: 1. Missing doses or

1. Stress the importance of taking more than
consistent and compliant use of prescribed can affect
calcium supplements. the balance of calcium
in the body.

2. Encourage individuals to 2. to assess the ongoing

have regular follow-up need for calcium
appointments with their supplementation,
healthcare provider especially if there are
changes in health
52
 conditions or
medications.
3. Emphasize the importance 3. Calcium needs vary,
of not self-dosing with calcium and excessive intake
supplements without can lead to adverse
consulting a healthcare effects.
professional.

53
 Drug Study

GENERIC/ CLASSIFI INDICA DOSAGE MECHANIM NURSING CONSIDERATION/ RATIONALE

TRADE CATION TION OF ACTION PATIENT’S TEACHING
NAME
KCL Electrolyte Hypokale 750 Replaces OBSERVATION: 1. Those could lead to further
(potassium supplement mia mg/tab potassium 1. Monitor and report signs of GI ulceration complications that needs immediate
chloride) TID and (esophageal or epigastric pain or hematemesis). medical attention.
maintains
potassium 2. Monitor patients receiving parenteral 2. Small changes in potassium levels can
levels. potassium closely with cardiac monitor. have a big effect on the activity of nerves
Irregular heartbeat is usually the earliest clinical and muscles, especially the heart. Low
indication of hyperkalemia. levels of potassium can lead to an
irregular heartbeat or other electrical
3. Report continuing signs of potassium deficit malfunction of the heart.
to physician: Weakness, fatigue, polyuria,
polydipsia.mj 3. To ensure patient safety and to respond
to patients' needs accordingly.
MANAGEMENT:
1. Do not use any salt substitute unless it is specifically 1. These foods contain potassium, and
ordered by the physician. These contain a substantial eating them can increase the level of
amount of potassium and electrolytes other than potassium in your blood.
sodium.
2. To ensure the amount of medicine
2. Do not self-prescribe laxatives. Chronic laxative use taking is both safe and effective.
has been associated with
diarrhea–induced potassium loss.
3. Persistent vomiting, diarrhea or both
also can result in excessive potassium loss
3. Notify physician of persistent vomiting because
54
losses of potassium can occur from the digestive tract.

EDUCATION: 1. This helps ensure that potassium levels

1. Stress the need for regular monitoring of serum remain within the therapeutic range and
potassium levels through blood tests. avoids complications like hyperkalemia or
hypokalemia.
2. Discuss the importance of maintaining a balanced diet
rich in potassium-containing foods, while being cautious 2. To consult their healthcare provider about
about excessive intake. dietary considerations.

3. Stress the importance of attending follow-up 3. To monitor the effectiveness of the

appointments with their healthcare provider
treatment and address any concerns or
adjustments needed.

55
 Drug Study
GENERIC/TRADE CLASSIFI INDICATION DOSAGE MECHANISM NURSING CONSIDERATION/ RATIONALE
NAME CATION OF ACTION PATIENT’S TEACHING

Paracetamol ADULT: OBSERVATION:

Antipyretic To reduce fever
Decrease fever 1. Check that the patient is not taking any other 1.This may damage your liver and can
(Biogesic) 500
in viral and
by a medication containing be fatal.
mg/tab
bacterial
hypothalamic paracetamol.
infections. PO q4hrs 2.This indicates over dosage from
effect leading
PRN 2. Monitor for signs and symptoms of hepatotoxicity. medication.
to sweating
and 3. This is to know if the medication is
3. Evaluate therapeutic response. effective or not.
vasodilaton

Inhibits MANAGEMENT: 1. To minimize GI upset.

pyrogen effect 1. Have patient take drug with food or milk. 2. Different body age and weight
on the 2. Do not give children more than 5 doses in 24h unless requires a specific dosage of
hypoythalmic - prescribed by medication that the body could
heat-regulating intake.
physician.
centers 3. So that the doctor will be able to
address the problem and would
3. If symptoms persist, refer it to the attending physician.
Inhibits CNS prescribe another medical approach.
prostaglandin
synthesis with EDUCATION:
1. Alcohol increases the risk of liver
minimal
1. Educate patient not to intake alcohol while taking
damage that can occur if an overdose
impact on
paracetamol.
of paracetamol is taken.
peripheral
prostaglandin 2. This is to avoid over dosage and

56
synthesis. potential liver damage.
2. Instruct patient not to intake alcohol while taking
paracetamol. 3. Children are naturally curious and
might accidentally consume the
3. Advice parents to keep all paracetamol well out of the medication.
reach of
children.

57
 Drug Study
GENERIC/TRADE CLASSIFICATION INDICATION DOSAGE MECHANISM NURSING CONSIDERATION/ RATIONALE
NAME OF PATIENT’S TEACHING
ACTION
Tranexemic Acid Antifibrinolytics. For short term ADULT: Works by OBSERVATION:
prevention in patients 500mg 1 inhibiting the
(Cyklokapron) 1.Monitor vital signs, including blood 1. Proper administration of
with hemophilia. ampule q6h activity of
pressure, heart rate, and respiratory rate, tranexamic acid is essential
x3 doses plasminogen,
every 4-6 hours to detect any signs of to ensure its effectiveness
an enzyme that
hypertension or tachycardia, which may and prevent adverse effects.
converts to
indicate the development of thrombosis.
plasmin, which
breaks down 2.May cause renal
2.Monitor urine output and renal function
fibrin, a protein impairment, particularly in
tests, such as blood urea nitrogen (BUN)
that forms patients with preexisting
and creatinine, to detect any signs of renal
blood clots. renal impairment.
impairment.
Therefore, it is essential to
monitor renal function
tests and urine output to
detect any signs of renal
3.Monitor for signs of allergic reactions, impairment and
such as hives, itching, swelling, and intervene promptly.
difficulty breathing, and notify the 3.May cause allergic
healthcare provider immediately. reactions in some patients.
Therefore, it is essential to
monitor for signs of allergic
reactions and intervene
promptly.
58
 MANAGEMENT:
1. Administer tranexamic acid as prescribed 1.Proper administration of
by the healthcare provider, following the tranexamic acid is essential
manufacturer's instructions for preparation to ensure its effectiveness
and administration. and prevent adverse effects.
2.Proper administration of
2. Ensure that the patient is adequately tranexamic acid is essential
hydrated before and during tranexamic acid to ensure its effectiveness
administration to prevent renal impairment. and prevent adverse effects.
Dehydration may
increase the risk of renal
impairment in patients
taking tranexamic acid.
Therefore, it is essential to
ensure that the patient is
adequately hydrated before
and during tranexamic acid
3. Monitor for signs of bleeding, such as administration.
excessive bruising, bleeding from the gums 3.May increase the risk of
or nose, and heavy menstrual bleeding, and thrombosis, which may lead
notify the healthcare provider immediately. to an increased risk of
bleeding in some patients.
Therefore, it is essential to
monitor for signs of
bleeding and intervene
promptly.

59
 EDUCATION: 1. To ensure that the

1. Inform the patient about the indications, patient understands the

mechanism of action, and potential adverse medication's purpose,

effects of tranexamic acid. potential benefits and

risks, and how to manage
any adverse effects.
2.To ensure that the
2.Inform the patient about the importance
patient understands the
of proper hydration before and during
importance of proper
tranexamic acid administration to prevent
hydration and how to
renal impairment.
manage dehydration.

3.Inform the patient about the signs and 3.To ensure that the patient
symptoms of allergic reactions and the understands the signs and
importance of symptoms of allergic
reactions and how to
manage them promptly.

60
 Nursing Care Plan
ASSESSMENT DIAGNOSIS OUTCOMES/ NURSING INTERVENTIONS RATIONALE EVALUATION
OBJECTIVES
Subjective: Ineffective Short term: Observation: 1. Pulses are indicative of adequate After 8 hours of nursing
“Nabudlayan ko Tissue 1. Monitor distal Pulses frequently perfusion intervention, the patient
After 8 hours of nursing
mag ginhawa kun Perfusion 2. Monitor the color, temperature, 2.Color of extremities will maintain
intervention, the patient will:
mag higda ko daw related to & sensation of all extremities. should be usual for cardiopulmonary
 Maintain
malumos ko” as decreased ethnicity. Pallor, cyanosis, perfusion as evidenced by
cardiopulmonary
verbalized by the oxygen- 3. Monitor laboratory studies such as or mottled skin color decreased episode of
perfusion as evidenced
patient. carrying hemoglobin, hematocrit and RBC. indicate a blockage in dyspnea, normal O2 sat,
by decreased episode of
“mag apat gane ka capacity of perfusion to the extremity. RR within normal range.
dyspnea, normal O2 sat,
tikang pakadto sa the blood 3. Normal values indicate adequate
RR within normal range.
CR ginahapo secondary Management: tissue perfusion After 2 days of nursing
nako” as to anemia 1. Encourage deep breathing exercise 1. Deep breathing exercise help in intervention, the
Long term:
verbalized by the 2. Encourage and assist the patient in lung expansion. patient will maintain
patient After 2 days of nursing adopting positions that optimize lung 2. The diaphragm has more space to adequate peripheral
“Kadasig lang intervention, the patient will: expansion and oxygenation, such as sitting contract and descend during perfusion as evidenced by
saakon makapoy  maintain adequate upright or semi-Fowler's position inspiration. This allows for better capillary refill less than 2
kag mahapo kun peripheral perfusion as lung expansion, maximizing the seconds.
mag hala ka giho” evidenced by capillary amount of air that enters the lungs.
as verbalized by refill Dependent: 1. To help control and reduce
the patient 1. Administer Hydroxyurea as prescribed. production of white blood cells
2. Blood component therapy (Blood 2. Blood transfusion increases the
transfusion) as ordered. patient’s blood volume and raising
the hemoglobin level.

61
 Education: 1. To promote wellness
Objective:
1. Encourage discussion of feelings (teaching/discharge considerations)
-tachypnea regarding prognosis/long term effects of 2. Training for a bowel movement
- dyspnea condition. further impairs cardiac output and it
-pallor 2. Educate patient to avoid straining and demands more oxygen; to increase
-weakness eat foods rich in iron the capacity of the RBC to carry
-capillary oxygen throughout the body
refill > 5 3.Identify necessary changes in lifestyle 3. To monitor hemoglobin levels
secs HCT: and assist client to incorporate disease and assess treatment progress
0.18 L/L management
HGB:
60.0
g/L
Vital
signs:
RR: 25breaths/min
O2 sat: 90% with
5 liters per minute
via nasal cannula

Urine Output:
12ml/hr
150ml in a day

References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurses Pocket Guide (11th ed., pp.705-713). Philadelphia, Pennsylvania: F.A. Davis Company.

62
 Nursing Care Plan

ASSESSMENT DIAGNOSIS OUTCOMES/ NURSING INTERVENTIONS RATIONALE EVALUATION

OBJECTIVES
Subjective: Decreased Short term: Observation: 1. Monitoring vital signs is crucial to assess the
After 8 hours of nursing
“ Taas akun dugo Cardiac 1. Monitor blood pressure, heart patient's overall cardiovascular status and detect any
After 8 hours of intervention, the patient will
pag kuha sang Output rate, and respiratory rate signs of worsening hypertension or hypotension.
nursing
Participate in activities the
BP ko kagina” as related to regularly.. 2. Regular monitoring of hemoglobin, hematocrit,
intervention, the
reduce the workload of the
verbalized by the increased 2. Monitor hemoglobin, and platelet counts helps identify and address
patient will:
heart.
patient afterload on hematocrit, and platelet counts. anemia and bleeding tendencies promptly.
participate in
-Goal met the patient

“Gina budlayan the heart Assess for signs of bleeding, 3. Maintaining an optimal fluid balance is
activities the
ako mag ginhawa and reduced such as petechiae, ecchymosis, essential to prevent complications such as fluid participated in activities to
reduce the
kg gapin ot oxygen- and melena. overload or dehydration that can contribute to reduce workload of the
workload of
dughan ko kun carrying 3. Monitor intake and output. changes in cardiac output. heart such as stress
the heart.
mag hala ka capacity as 4. Assess for signs of fluid 4. Early identification and management of anemia management and
giho” as evidenced overload or dehydration. symptoms help improve oxygenation and reduce the therapeutic regimen.
Long term:
verbalized by the by 5. Check for peripheral pulses. workload on the heart.
After 2 days of
patient hypertensio 5. Weak pulses are present in reduced stroke After 2 days of nursing
nursing intervention,
n and low volume and cardiac output. intervention
the patient will:
hematocrit. Management: The patient display
display
hemodynamic

1. Elevate the head of the bed and 1. Elevating the head of the bed reduces preload,
Objective: hemodynamic
assist the client in activities of making it easier for the heart to pump blood. improvements as
BP: 140/80mmHg improvements
daily living. Assisting the client with ADLs conserves the evidenced by decreased
HCT: 0.13 L/L as evidenced by
2. Advise the client to use a client’s energy and prevents exertion-related stress blood pressure from
(September 16, decreased
commode or urinal for toileting on the heart. 140/80 to 130/80
2023) blood pressure
and avoid using a bedpan. 2. Getting out of bed to use a commode or urinal Heart rate: From 109 to 60-
HCT: 0.18 L/L from 140/80 to
100 bpm
63
(September 23, 130/80; Heart 3. Keep the patient on bed in does not stress the heart more than staying in bed to
-Goal unmet the patient
2023) rate:60-100bpm position of comfort the toilet. In addition, getting the client out of bed
expired
HR: 109bpm 4. Instruct client to avoid/limit minimizes complications of immobility and is often
-Weak pulses activities that may stimulate preferred by the client.
Radial, Brachial, valsalva response such as, rectal 3. Decrease oxygen consumption and risk of
dorsalis pedis stimulation, bearing down during decompensation
-Pallor skin bowel movement, spasmodic 4. Prevent cardiac pressure and/or impede blood
-capillary refill >5 coughing. flow.
seconds
Dependent: 1.Blood transfusions increase oxygen-carrying
1. Administer intravenous fluids capacity, addressing anemia and improving cardiac
judiciously based on fluid output.
balance needs. 2. Appropriate fluid management ensures adequate
2. Administer prescribed blood preload for the heart without causing fluid overload
transfusions as needed. or exacerbating hypertension.
3. Administer antihypertensive 3. Controlling hypertension reduces the workload on
medications as prescribed. the heart and helps maintain optimal cardiac output.

Education: 1. Patient understanding and adherence to the

1. Educate the patient and family treatment plan are crucial for managing
about adhering to prescribed complications and improving cardiac output.
medications and treatments. 2.Stress management techniques empower
2. Teach the patient stress individuals to cope with and reduce the impact of
management technique stress on their physical and mental well-being.

References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurses Pocket Guide (11th ed., pp.145-151). Philadelphia, Pennsylvania: F.A. Davis Company.

64
 Nursing Care Plan
ASSESSMENT DIAGNOSIS OUTCOMES/ NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTIONS
Subjective: Risk for injury Short term: Observation: 1. Increased heart rate After 6 hours of nursing
“nagsuluka na siya nga related to After 6 hours of nursing 1. Assessed and and orthostatic change a intervention, skin is
may upod dugo” as decreased platelet intervention, skin will: monitored vital signs company bleeding. intact with no signs of
verbalized by the SO of count secondary  remain intact with no 2. Assessed for any signs 2. Bleeding may be bleeding
the patient. to Acute Myeloid signs of bleeding and of bleeding obvious(bruises/petech iae
“pagpangihi ko may Leukemia will be free from any 3. Monitored platelet count epistaxis, bleeding gums, Goal partially met.
upod dugo sa akon ihi” injury. abdominal pain)
as verbalized by the 3. Spontaneous bleeding
patient Long term: can occur at platelet -urine and stool are still
“damo na sha pasa pasa After 3 days of nursing Management: count not free from blood and
sa iya lawas kag intervention, the patient 1. Encourage use of soft- 1. Fragile tissues and still monitored
gahubag ang iya gums” will: bristle toothbrush, sponge altered clotting
as verbalized by the SO  urine and stool will or mild mouthwash to clean mechanisms high risk of -RBC and platelet as
of the patient. be free from blood teeth and gums. hemorrhage. well is still monitored.
 restores/normalizes 2. Administer medications 2. To help increase low
RBC count. such as corticosteroids as platelet count
Objective:
 will maintain reduced prescribed. 3. To avoid any minor or
-Ecchymosis
risk of bleeding as 3. Avoid invasive major injury that may
-Blood streak in
evidenced by normal procedures as possible cause bleeding
vomit(Hematemesis)
platelet and absence of 4. Maintained safe
-swollen gums 4. To prevent
any signs of environment for
Blood count shows falls/injury.
bleeding(ecchymosis) patient.
reduced:
65
HGB: 60.0 g/L 5. Provide soft diet
5. help reduce gum
Platelet: 10 10^9/L
irritation
HCT: 0.18 L/L Education:
1. These activities can
1. Instruct patient to avoid
damage mucous
forceful blowing, coughing,
membrane mechanism
sneezing and straining

References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurses Pocket Guide (11th ed., pp.414-418). Philadelphia, Pennsylvania: F.A. Davis
Company.

66
 Nursing Care Plan

ASSESSMENT DIAGNOSIS OUTCOMES/ NURSING RATIONALE EVALUATION

OBJECTIVES INTERVENTIONS
Subjective Altered body Short term: Observation: 1. Flushed face with skin that is hot to touch, After 2 hours of nursing
data: temperature weakness, fatigue, headache, and abnormal interventions, the patient’s
After 2 hours of 1. Assess for signs of hyperthermia.
“Gapalang init related to vital signs are possible Temperature will decrease at
nursing
ko kag daw bacterial indicators of hyperthermia. least from 38 degree Celsius
interventions, the 2. Observe for shaking chills and
gapalangluya invasion 2. Chills often ptrcede during high temperature to 37. 5
patient’s profuse Diaphoresis
lawas ko” as secondary to & presence of generalized infection
Temperature will: 3. Monitor neurological status.
verbalized by Leukemia. 3. Note the level of consciousness, orientation,
 decrease at least
the patient pupil reaction, and any posturing. Confusion and Goal met
from 38 ˚ C to
“Nahilanat na delirium may occur as the condition worsens.
37. 5˚ C Management:
si mama pero
1. Implement surface cooling
gadula dula mn 1. May help reduce fever. After 8 hours of nursing
measures. Such as Tipid Sponge
lang” as 2. Administer acetaminophen orally if the interventions: patient will
Long term: bath. Cooling blankets can be
verbalized by patient is awake, or IV if not able to tolerate PO maintain core body
applied to decrease body
the SO After 8 hours of medications. temperature within normal
temperature.
“sakit akon nursing interventions, 3. Administer IV fluids to treat dehydration. limits
2. Administer antipyretics.
ulo” as patient will: Cooled IV fluids can further help in decreasing Goal partially met - patient
Such as paracetamol as
verbalized by maintain core the body temperature. maintains care body
 ordered.
the patient body temperature temperature from 37.8 to
3. Rehydrate.
within normal 37.5
limits Education:
1. Patient may be uncomfortable and refuse to
1. Educate the importance of Tipid
perform Tipid sponge bath.
Sponge bath

67
Objective Data: 2. Discuss the symptoms of 2. Informing the family about these signs will
(Sep. 23, 2023) Leukemia help them to recognize heat stroke/exhaustion
-Warm to touch and to conduct prompt management.
-Patient is under
reverse isolation
Temp: 38˚ C
WBC: 284.8
10^9/L

References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurses Pocket Guide (11th ed., pp.383-387). Philadelphia, Pennsylvania: F.A. Davis Company.

68
 Nursing Care Plan

ASSESSMENT DIAGNOSIS OUTCOMES/ NURSING RATIONALE EVALUATION

OBJECTIVES INTERVENTIONS
Subjective: Fatigue related to Short term: Observation: After nursing
“bisan mag tindog or mag decreased hemoglobin Within 8hours of duty, 1. Determine ability to 1. To assess interventions:
pungko gaka kapoy nako as evidenced by patient will be able: participate in activities/level causative/contributing factors. -The patient was able to
na”as verbalized by the reported lack of  to have adequate of mobility. 2. Helps in developing a plan have adequate rest
patient energy secondary to rest periods. 2. Have patient rate fatigue for managing fatigue. periods.
“Bisan nakatulog nako Anemia using a numeric scale.
daw kapoy man ko Management: 1. To provide sense of control -The patient is limited to
gihapon” as verbalized Long term: 1. Assess psychologic and and feelings of perform ADLs and will
by the patient Within 2 days of duty, personality factors that may accomplishment report an improved
“daw hindi nalang ko patient will be able: affect reports of fatigue 2. To evaluate fluid status sense of energy.
gusto mag sege giho kay  to perform ADLs level. and cardiopulmonary
dasig lang ko makapoy and will report an 2. Monitor vital signs. response to activity. Goal partially met
kag mahapo” as verbalized improved sense of 3. To assist client cope with
3. Keep bed in low position
by the patient energy. fatigue and manage within
and assist with ambulation.
Individual limits of ability.
4. Encourage pacing 4. To prevent overexertion.

69
 activities throughout the day. 5. To conserve energy.
Objective:
- body weakness 5. Prioritize tasks and focus
Blood count shows on essential activities
reduced: Dependent:
1. Presence of hypoxemia
HGB: 43.0 g/L (September 1. Provide supplemental
reduces available oxygen
16, 2023) oxygen.
for cellular uptake and
HGB: 60.0 g/L (September
2. Regulate IVF as ordered. contributes to fatigue.
23, 2023)
2. To maintain
HCT: 0.18 L/L Collaborative:
hydration
Motor strength: ++ 1. Refer to
1. To maintain/increase
physical/occupational
strength and muscle
therapy for programmed
tone and to enhance
daily exercises and
sense of well-being
activities.
2. To promote
2. Refer to
wellness/teaching discharge
counseling/psychotherapy as
considerations.
indicated.
Education:
1. To indicate the need to
1. Instruct client in ways to
alter activity level.
monitor responses to
activity and significant
2. To promote wellness
signs/symptoms.
(teaching
2. Assist client/SO to
discharge/consideratio ns)
develop plan for activity
3. To avoid occurrence
and exercise within
of further problems
individual ability.

70
 3.Instruct client in ways to related to activity
monitor responses to
activity.
References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurses Pocket Guide (11th ed., pp.307-312). Philadelphia, Pennsylvania: F.A. Davis Company.

71
 Discharge Summary

Nursing Goal: Nursing Order: Rationale:

Medication Upon discharge patient will: Instructed pt on the ff:
be able to take medications as prescribed  Amlodipine 10mg for HTN  To decrease BP
without skipping a dose.  Other medicines as directed such as for anemia,  Helps body make RBC
vitamins (folic acid),Hydroxyurea, calcium for KCL  Helps prevent formation of
sickle-shaped RBC

Exercise Maintain daily exercise regimen  Physical therapist can help you design a fitness  will give you more energy and
program that matches your strength and energy fight fatigue.
levels. Can do low intensity aerobic exercise.  can promote relaxation and has
 Can do deep breathing exercise. been widely used as a technique
to manage stress and induce a
sense of calm
Therapy Follow the physician’s appraisal or advice  Blood transfusion as ordered  To replace blood loss
regarding to patient’s condition especially  Chemotherapy, Radiation  kills fast growing cells
the platelet is very low. throughout the body including
cancer cells and normal, healthy
cells.
Hygiene Maintain good hygiene  Wash your hands often  To avoid transmission of
 Avoid people who are sick bacteria and infection
 Use soft toothbrush  To decrease risk of exposure to
infectious agents.
 To avoid bleeding of gums.

72
 OPD Meet physician’s follow up appoint as  Call doctor if you have signs of bleeding, dyspnea,  To attend the signs and
heart begins to beat very fast, rectal pain, blurred
scheduled. symptoms of bleeding as soon
vision, questions or any concerns regarding the
as possible and be able to
condition.
prevent it from getting worse.

Diet Maintain foods that may help feel better  Eat fish, poultry, red meat, variety of fruits and  Protein to help body heal and
and have more energy. Drink healthy vegetables, low fats and healthy oils. strengthen immune system.
liquids.  Drink atleast 7-8 glasses of water  Proper hydration helps maintain
the fluidity of blood, allowing
RBCs to flow more easily and
deliver oxygen to tissues and
organs.
Spiritual Experience personal relationship with God  Encouraged patient to keep contact with family and  Spiritual care has positive
through birth experience and family church members for spiritual support. effects and make patient being
support. hopeful.

73
 CHAPTER IV

GENERAL EVALUATION OF THE STUDY

Nursing Education

This case study provides information, including the medications, disease

mechanism , factors, signs and symptoms and it’s medical and nursing management.

Nursing Practice

This study aims to provide knowledge by providing additional nursing

understanding and skills related functionality regarding to AML Severe anemia on the

nurse practitioners to provide holistic and appropriate interventions in caring for

patients with this condition, with a view of improving the client's understanding for

better disease management, participation with treatments, and prevention of recurrence

of complication.

Nursing Research

The investigation will delineate the occurrence of severe anemia as a secondary

manifestation in Acute Myelogenous Leukemia. The study will expound upon the

development and coexistence of this condition in patients, exploring its association

with risk factors that heighten the probability and severity of infection, as well as the

potential failure of antibiotic therapy and other treatment regimens. This research aims

to enhance the existing body of knowledge and serve as an supplementary reference for

researchers seeking a more profound comprehension of the disease. The insights gained

from this study may contribute to the development and enhancement of new

interventions and management strategies.

74
 Personal Reaction to Learning

Despite being limited to only two shifts, we managed to assess the patient's

condition and conduct an interview that provided us with a better understanding of AML

severe anemia. As student nurses, working on this case proved to be a valuable learning

experience, guided by our adviser. We gained insights into formulating nursing care

plans for Mrs. White in relation to her illness. This case study also equipped us with the

skills to interpret diagnostic tests, ensuring that the results align with our patient's

condition and recognizing the significance of each finding.

Furthermore, through a drug study, we were able to discern the purpose of each

medication and its relevance to our patient's needs and overall health. Lastly, this case

emphasized the importance of seeking guidance from a higher power. We sought the

Lord's knowledge and wisdom, aiming to complete the case with a deepened

understanding and to glean valuable insights into our patient, her illness, and potential

interventions to aid her.

75
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79
 APPENDICES

Appendix A: Letter to the Patient

Central Philippines Adventist

College Alegria, Murcia
Negros Occidental 6129

Dear Mrs White,

We, the nursing students of Central Philippine Adventist College namely Kayla Grace
Anacleto, Jezrale fame Antoy, DJ Lorenne Zoe Barnedo, Ricky Ryan Calopez , and
Jellamarie Cadiz are writing for consent to allow us to use your medical records as our
basis of our case study as requirement of our program.

We are the student nurses on duty during your admission. We humbly seek your
consent to use your data for our case study. We are assuring the confidentiality of the
received data and we are responsible of any cause of any dispersed data from the
patient.

We look forward to receive the above request. If our request cannot be honored, please
inform us through sending us a message in our gmail account
([email protected]).

Sincerely yours,

Kayla Grace Anacleto

Jezrale Fame Antoy
Syville Bantayan
DJ Lorenne Zo Barnedo
Ricky Ryan Calopez
Jellamarie Cadiz

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 Appendix: Letter to the Hospital

Central Philippines Adventist

College Alegria, Murcia
Negros Occidental 6129

Dear Record Administrator,

We, the nursing students of Central Philippine Adventist College namely Kayla Grace
Anacleto, Jezrale fame Antoy, Syville Bantayan, DJ Lorenne Zoe Barnedo, Ricky
Ryan Calopez, and Jellamarie Cadiz, are requesting for a patient data of Mrs. White*,
including any treatment notes, test results, laboratory findings and/or discharge reports
and other record on the ward.

We are the student nurses on call while the patient was being admitted. We respectfully
ask for your permission to release the data for our case study. We guarantee the privacy
of the information we collect, and we bear all responsibility for any unauthorized
distribution of patient data.

We look forward for your positive response. Thank you.

Sincerely yours,

Kayla Grace
Anacleto Jezrale
fame Antoy
Syville
Bantayan
DJ Lorenne Zoe
Barnedo Ricky
Ryan Calopez
Jellamarie Cadiz

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 Curriculum Vitae

Name: Kayla Grace G. Anacleto

Address: Sta. Catalina Phase III Subd, Bago City
Birth date: Feb 22, 2001
Email address:[email protected]
Senior High school: University of ST. La Salle
Junior High school: Brookside Garden Academy
Elementary school: Bacolod Adventist Elementary School

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 Curriculum Vitae

Name: Jezrale Fame S. Antoy

Address: Igbonglo, San Jose, Antique
Birth date: August 30, 2001
Email address: [email protected]
Senior High school: St. Anthony’s College
Junior High school: Antique Nationale School
Elementary school: Delegate Angel Salazar Jr. Memorial General Hospital

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 Curriculum Vitae

Name: Syville I. Bantayan

Address: Inayauan, Cauayan Negros Occidental
Birth date: December 1, 2000
Email address: [email protected]
Senior High School: St. Joseph High School
Junior High school: St. Joseph High School
Elementary school: Inayauan, Central Elementary School

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 Curriculum Vitae

Name: DJ Lorenne Zoe R. Barnedo

Address: Abongan Taytay Palawan
Birth date: September 13, 2001
Email address: [email protected]
Senior High school: Central Philippine Adventist- Academy (Negros Occidental)
Junior High school: Faith Adventist Academy (Taytay Palawan)
Elementary school: Abongan Adventist Elementary school (Taytay Palawan)

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 Curriculum Vitae

Name: Jella Marie G. Cadiz

Address: Aglipay St. Bais City Negros Oriental
Birth date: Jan 23, 2002
Email address: [email protected]
Senior High school: Bais City National Science High School
Junior high school: Bais City National Science High School
Elementary school: Bais City National Science High School

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 Curriculum Vitae

Name: Ricky Ryan D. Calopez

Address: Ayala North Point, Talisay City, Negros Occidental
Birth date: March 6, 1999
Email address: [email protected]
Senior High school: University of St. La salle, BCD city, Neg. Occidental
Junior high school: La Consolacion College, Murcia, Negros Occidental
Elementary school: La Consolacion college, La Carlota City, Neg. Occidental

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