Search This Blog

Showing posts with label Altered Tissue Perfusion. Show all posts
Showing posts with label Altered Tissue Perfusion. Show all posts

Saturday, December 6, 2014

Activity Intolerance and Altered Tissue Perfusion r/t Leukemia

Nursing Care Plan for Leukemia


Nursing Diagnosis for Leukemia : Activity Intolerance related to general weakness, increased metabolic rate.

Goal:
The client is able to tolerate the activity.

Expected outcomes:
  • Increased tolerance activity can be measured.
  • Participate in activities that can be measured.
  • Shows signs of physiological decline intolerant.
Nursing Intervention:
  • Evaluation reports weakness, note the inability to participate in activities.
  • Implementation of energy saving techniques.
  • Schedule eat about chemotherapy.

Collaboration:
  • Give supplemental O2.

Nursing Diagnosis for Leukemia : Altered Tissue Perfusion related to cessation of blood flow, secondary; destruction of human existence.

Goal:
Adequate perfusion.

Expected outcomes:
  • Balanced inputs and outputs.
  • Urine output of 30 mL / h.
  • Capillary refill less than 2 seconds.
  • Stable vital signs.
  • Strong peripheral pulses palpable.

Nursing Intervention:
  • Monitor vital signs.
  • Assess the skin to the cold, pale, humidity, capillary refill.
  • Note the change in the level of consciousness.
  • Maintain adequate fluid intake.
  • Evaluation of edema.
Collaboration:
  • Supervise laboratory tests: blood gas analysis, AST / ALT, CPK, BUN.
  • Serum electrolytes, provide a replacement as indicated.
  • Give hypo osmolar fluid.