Nursing Care Plan AML

Nursing Care PlanPatient’s Name: Boy Chu Lo (8 years old) Medical Diagnosis: Acute Myeloid Leukemia (AML)

Assessment Planning EvaluationCues Nursing

DiagnosisSituational

AnalysisExpected Outcome

Nursing Intervention Rationale Outcome Assessment

Subjective Cues(s):

“Nanghihina po ako” as verbalized by Chulo

Objective Cue (s):

-With ongoing chemotherapy(Cytarabine)

V/STemp: 38.5oC (Hyperthemia)RR: 18cpm (Bradypnea)HR: 120bpm (Tachycardia)

CBCWBC is elevated but immature:13.59x109/L Neutrophil: 0.18% Lymp: 0.81%(Deficient immunity and Maladaptive Stress Response)PLT is low: 33x109/LHgb is low: 84%Hct is low : 25%

PallorWeaknessEasy fatigabilityDyspnea

Ineffective protection r/t abnormal blood profile and drug requirement (anti-neoplastic) as manifested by elevated body temp., bradypnea, tachycardia, deficient immunity (Low matured WBC and High immature WBC), Low platelet count and Hgb, Pallor, Weakness, Easy fatigability, and Maladaptive to stress response.

Decreased in the ability to guard self from internal or external threats such as illness or injury.

After 24 hrs of nursing intervention Chulo will be protect frominfection and bleeding hazardThat may contribute to patient’s health condition and may demonstrateImprovement in vital signs, laboratory result, and lessen the difficulty of body function.

Objectives:a) To protect

client from Bleeding hazards and lessen the risk for injury.

b) To protect client from infection.

a. To protect client from Bleeding hazards and lessen the risk for injury.

Independent:1. Monitor v/s

2. Inspect skin/mucous membrane for petechiae, ecchymotic areas, note bleeding gums, frank or occult blood in stools and urine, oozing from invasive-line site

3. Implement measure to prevent tissue injury/ bleeding (Avoid Sharp Object, Minimize invading procedure,Avoid Contact Sport) (e.g. gentle brushing of teeth or gums with soft toothbrush, cotton swab, or sponged tipped applicator, avoiding needlesticks when possible, using sustained pressure on oozing puncture/IV sites.

4. Limit Oral Care to mouthwash if indicated (a mixture of 1/4tsp. baking soda or salt in 4-8 oz water or hydrogen peroxide in water). Avoid mouthwashes with alcohol

5. Provide Soft Diet

6. If bleeding is present do the ff.: (Apply pressure, Cold Compression, Elevation)

1. as baseline data

2. Suppression of bone marrow and platelet production. Places patient at risk for spontaneous/ uncontrolled bleeding (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

3. Fragile tissues and altered clotting mechanisms. Increase the risk of hemorrhage following even minor trauma. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

4. When bleeding is present, even gentle brushing may cause more tissue damage. Alcohol has a drying effect and may be painful to irritated tissues. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

5. May reduce gum irritation (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

6. To relieved bleeding cessation. (Nanda,2008. Ineffective Protection. Nurses Pocketbook. 11th Ed pg 547-

Goal Met:After 24 hrs of nursing intervention Chulo was protect frominfection and bleeding hazardThat may contribute to patient’s health condition and he demonstrateImprovement in vital signs, laboratory result, and lessen the difficulty of body function.

1. Theclient protected from Bleeding hazards and the risk for injury had been lessen.

2. The client protected from infection.


7. Avoid use of aspirin-containing antipyretics.

Dependent:1. Administer RBCs, Platelet, Clotting Factors.

2. Maintain External Central Vascular access Device (subclavian or tunneled catheter or implanted port).

Collaborative:1. Laboratory Studies(Platelet, Hbg/Hct, clotting

b. To protect client from infection.

Independent:1. Isolation Precaution (Restrict Isolation): Place in private room. Screen/Limit visitors as indicated. Prohibit use of live plants/ cut flowers. Restrict fresh fruits and vegetables or make sure they are washed or peeled.

549)

7. Aspirin can cause gastric bleeding and further decrease platelet count (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. Restores/ Normalize RBC count and carry oxygen carrying capacity to correct anemia. Used to prevent/ treat hemorrhage. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Eliminate peripheral venipuncture as source of bleeding. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. When the platelet is less than 20,000.mm (because of proliferation of WBCs and/or bone marrow suppression secondary to antinoplastic drugs), patient is prone to spontaneous life-threatening bleeding. Decreasing Hb/Hct is indicative of bleeding (may be occult). (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. Protect patient from potential sources of pathogens/ infection Note: Profound bone marrow, suppression, neutropenia, and chemotherapy place patient at great risk for infection (Jhonroks, Nusing Care Plan for Leukemias, Scribd,


2. Require good hand washing protocol for all personnel and visitors

3. Monitor Temperature. Note correlation between temperature elevations and chemotherapy treatments. Observe for fever associated with tachycardia, hypotension, subtle mental changes.

4. Prevent chilling. Force fluids, administer tepid sponge bath.

5. Encourage frequent turning and deep breathing.

6. Auscultate breath sounds, noting crackles, ronchi, inspect secretions for changes in characteristic, .g., increased sputum production or change in sputum color. Observe urine for sign of infection, e.g cloudy, foul smelling, or presence of urgency or burning with voids.)

7. Handle patient gently. Keep linens dry/ wrinkle-free

17471597)

2. Prevents cross-contamination/reduces risk for infection. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

3. Although fever may accompany some forms of chemotherapy, progressive hyperthermia occurs in some types of infections, and fever (unrelated to drugs or blood products) occurs in most leukemia patients. Note: Septiceia may occur without fever. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

4. Helps reduce fever, w/c contributes to fluid imbalance, discomfort, and CNS complication. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

5. Prevent stasis of respiratory secretions, reducing risk of atelectasis/pneumonia. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

6. Early intervention is essential to prevent sepsis/septicemia in immunosuppressed person. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

7. Prevents sheet burn/ skin excoriation(Nanda,2008. Ineffective Protection. Nurses Pocketbook. 11th


8. inspect skin for tender, erythematous areas; open wounds cleanse skin with antibacterial solution.

9. Inspect oral mucous membranes. Provide good oral hygiene. Use a soft toothbrush, sponge, or swabs for frequent mouth care.

10. Promote good perianal hygiene. Examine perianal area at least daily during acute illness. Provide sitz baths, using betadine or hibiclens if indicated. Avoid rectal temperatures, use of suppositories.

11. Coordinate Procedures and test to allow for interrupted rest periods.

12. Encourage increased intake of foods high in protein and fluids with adequate fiber.

13. Avoid/ limit invasive procedures (e.g., venipuncture and injections) as possible.

Ed pg 547-549)

8. May indicate local infection Note; Open wounds may not produce pus because of insufficient number of granulocyte. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

9. The oral cavity is an excellence medium for growth of organisms and is susceptible to ulceration and bleeding. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

10. Promote cleanliness, reducing risk of perianal abscess can contribute to septicemia and death in immunosupressed patients. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

11. Conserves energy for healing, cellular regeneration. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

12. promotes healing and prevents dehydration. Note: Constipation potentiates retention of toxins and risk of rectal irritation/ tissue injury. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

13. Break in skin could provide an entry for pathogenic/ potentially lethal organisms. Use of central venous lines (e.g., tunneled catheter or implanted port) can effectively reduce need for frequent invasive


14. Provide nutritious diet, high in protein and calories, avoiding raw fruit, vegetables, or uncooked meats.

Dependent:Administer medication as indicated by physician;1. Penicillin G (pfizerpen) 1 mil unit , I.V q6 ANST as antibiotic

2. Colony-Stimulating factors: Doxorubicin (adriamycin) 20mg in PNSS to make 100cc/ss q4 ,I.V.Cytarabine (cytosine) 100mg in 500cc ANST q 12, I.V.

Collaborative:1. Monitor Laboratory studies e.g.: a. CBC, noting whether WBC count falls or sudden changes occur in neutrophils

b. Gram’s stain C/S

procedures and risk of infection. Note: Myelosuppression may be cumulative in nature, especially when multiple drug therapy (including steroids) is prescribed. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

14. Proper nutrition enhances immune system. Inimizes potential sources of bacterial contamination. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1.May be given prophylactically or treat specific infection (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Restores WBCs destroyed by chemotherapy and reduces risk of severe infection and death in certain types of leukemia. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. a. Decreased numbers of normal/ mature WBCs can result from disease process or chemotherapy, compromising the immune response and increasing risk of infection. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

b. Verifies presence of infections; identifies specific organisms and appropriate therapy. (Jhonroks,


c. Review serial chest x-rays.

2. Prepare for/ assist with leukemia-specific treatments such as chemotherapy, radiation, and/or bone marrow transplant.

Nusing Care Plan for Leukemias, Scribd, 17471597)

c. indicator of development/ resolution of resp. complications. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Leukemia is usually treated with a combination of these agents, each requiring specific safety precautions for patient and care providers. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)






Subjective Cue(s):“Medyo nahihirapan po akong huminga minsan” as verbalized by Chulo

Objective Cue(s):

With ongoing chemotherapy (Cytarabine), 5th day-With ongoing 0.3%NaCl 1 bottle 25gtts/min, I.V at Left metacarpal

-V/S:RR: 18cpm (bradypnea)PR: 120bpm (Tachycardia)

CBCHgb is low: 84%Hct is low : 25%

BruisesNauseaAbdominal painPallorWeaknessEasy FatigabilityCapillary Refill >3sec.Headache and dizziness

Ineffective Tissue Perfusion r/t inadequate red blood cell production as manifested by bradypnea, tachycardia, Nausea, Pallor, Abdominal pain, bruises, Nausea, Abdominal Pain, Capillary refill >3sec., Weakness, Easy Fatigability, Headache and dizziness.

Decreased in oxygen resulting in the failure to nourish the tissues at the capillary level.

After 24 hrs, of Nursing Intervention, Chu Lo will demonstrate increased tissue perfusion as individually appropriate.

Objectives:a) To identify

causative/ contributing factors.

b) To assisst client to correct/ minimize impairment and to promote healing.

c) To promote wellness.

a. To identify causative/ contributing factors.

Independent:

1. Note reports of increasing fatigue, weakness. Observe for tachycardia,pallor of skin/ mucous membranes, dyspnea , and chest pain. Plan patientactivities to avoid fatigue.

2. Note poor hygiene/ health practices(e.g., lack of cleanliness, poor dental care.)

Collaborative:1. Assess blood supply and

sensation (nerve damage) of affected area. Evaluates pulses/ calculate ankle- brachial index

b. To assisst client to correct/ minimize impairment and to promote healing.

Independent:1. Monitor V/S and Monitor I and

O

2. Elevate HOB (10 degrees) and maintain head/neck in midline

1. May reflect effects of anemia and cardiac response. To let the patient rest. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

2. May impacting tissue health. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

1. To evaluate actual/potential for impairment of circulation to lower extremities. Result less than 0.9 indicates need for close monitoring/ more aggressive intervention. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

1. As baseline data

2. To promote circulation/ venous drainage.

Goal Met:

After 24 hrs, of Nursing Intervention, Chu Lo demonstrate increased tissue perfusion as individually appropriate.

1. Causative contributors had been identified.

2. Correct/Minimize impairment and to promote client’s healing had been assisted

3. Wellness had been promoted.


or neutral position.

3. Encourage quiet, restful atmosphere.

4. Caution patient to avoid activities that increase cardiac workload (e.g., straining at stool).

5. Provide small/ easily digested.food and fluids, when tolerated and encourage rest after meals.

6. Encouraged early ambulation, when possible.

7. Discouraged sitting/standing for long periods, wearing constrictive clothing, crossing legs. Elevate the legs when sitting, avoid sharp angulation of the hips or knees.

8. Provide air mattress, foam padding, bed/foot cradle.

(Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

3. Conserves energy/ lowers tissue Oxygen Demand (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

4. To lessen the work of the heart. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

5. To maximize blood flow to stomach, enhancing digestion. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

6. Enhances venous return. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

7. To facilitate good blood flow. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

8. To protect extremities. (Nanda,2008. Ineffective tissue perfussion. Nurses


9. Encourage use of relaxation, exercises/ techniques.

10. Prevent exposure to cold, dressing warmly, and use of natural fibers.

Dependent:1. Oxygenation as indicated by

physician.

2. Blood transfusion, Packed RBC if Indicated by physician.

Collaborative:1. Diagnostic studies (e.g., X-Ray,

UTZ, CBC)

2. Assess with treatment of underlying conditions (e.g., fluid replacement/ rehydration,

Pocketbook. 11th Ed pg 705-714)

9. To decrease tension level. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

10. To retain heat more efficiently that may facilitate to vasodilation that allows the blood to facilitate good circulation/flow. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. To increased supply and prevent further. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. To provide client with RBC that is a mean for supplying oxygen through body tissue. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. To determine location/ severity of condition (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)

2. To improve tissue perfusion / organ function. (Nanda,2008. Ineffective tissue perfussion.


nutrients, treatmentof sepsis, medication) as indicated

c. To promote wellness.

Independent:1. E ncourage discussion of

feelings regarding prognosis/ long term effects of condition.

2. Discuss individual risk factors (e.g family history of cancer)

3. Demonstrate/ encourage use of relaxation activities, exercises/ techniques

4. Discuss preventing exposure to cold, dressing warmlyt, and use of natural fibers.

Nurses Pocketbook. 11th Ed pg 705-714).

1. To address the patient’s problem (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714).

2. Information necessary for client to make informed choices about remedial risk factors and commitment to lifestyle changes, as appropriate, to prevent onset of complication/ manage symptoms when condition is present (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)..

3. To decrease tension level. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)..

4. To retain heat more efficiently. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714)..


Collaborative:1. Review medical regimen and

appropriate safety measure and review specific dietaru changes/ restriction with client.

1. To closely monitor the patient’s progression. (Nanda,2008. Ineffective tissue perfussion. Nurses Pocketbook. 11th Ed pg 705-714).






Subjective Cue(s):“Nasusuka po ako” as verbalized by chulo

Objective Cue (s):

-With ongoing chemotherapy(Cytarabine)

I and O:1227ml intake = 905ml urine output

V/S:Temp: 38.5oC (Hyperthemia)RR: 18cpm (Bradypnea)PR: 120bpm (Tachycardia)

Wt: 19kg (wt. loss)

Nausea and VomitingAnorexiaGrimacePallorWeaknessEasy FatigabilityDecreased Skin turgorCapillary Refill >3secs.Increased fluid needDry Cracked Lips

Deficient Fluid Volume r/t Excessive Losses (chemotherapy effect), as evidenced by N/V, anorexia, Pallor, weakness, Easy Fatigability, Decreased Skin Turgor. Capillary Refill .>3secs., increased fluid need, Low hemoglobin, Low platelet, tachycardia, Wt. Loss, Dry Mucus membrane .

Decreased intravascular, interstitial, and/or intracellular fluid. This referes to dehydration with changes in sodium

After 24 hrs. of nursing intervention the Chulo will maintain fluid volume at a functional level as evidenced by individually adequate moist mucous membrane, good skin turgor, and prompt capillary refill.

Objectives:a) To assess

causative/ precipitating factors.

b) To evaluate degree of fluid deficit.

c) To correct/ replace fluid losses to reverse pathophysiological mechanisms.

d) To promote comfort and safety.

a. To assess causative/ precipitating factors.

Independent:1. Note possible conditions/

processes that may lead to deficits: 1) fluid loss(e.g., diarrhea/ vomiting, excessive sweating;2) environmental factor (isolation, restraints, exposure to extreme heat)

2. Determine effect of age.

3. Evaluate nutritional status, noting current intake, weight changes, problems with oral intake use of supplements.

b. To evaluate degree of fluid deficit.

Independent:1. Monitor v/S

2. Monitor I&O. Calculate insensible losses and fluidbalance. Note decreased urine output in presence of

1. Contributors of fluid volume deficit.(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

2. Very young are quickly affected by fluid volume deficit, and are least able to express need. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

3. Monitor precipitating factors. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

1. Changes may reflect effects of hypovolemia (bleeding/ dehydration). (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Tumor lysis syndrome occurs when destroyed cancer cellsrelease toxic levels of potassium, phosphorus, and

Goal met:

After 24 hrs. of nursing intervention the Chulo maintain fluid volume at a functional level as evidenced by individually adequate moist mucous membrane, good skin turgor, and prompt capillary refill.

a) Causative/ Precipitaing factors had been identified.

b) Degree of fluid deficit had been evaluated.

c) Fluid losses to reverse pathophysiological mechanisms had been correct ed/ replaced.

d) Comfort and


CBC:PLT is low: 33x109/LHgb is low: 84%

e) To promote wellness.

adequate intake. Measure specific gravity and urine pH

3. Weigh daily.

4. Evaluate skin turgor, capillary refill, and general condition of mucous membranes.

5. Note presence of nausea, fever.

c. To correct/ replace fluid losses to reverse pathophysiological mechanisms.

Independent:1. Encourage fluids of up to 3–4

L/day when oral intake is resumed.

2. Establish 24hrs. replacement needs and routes to be used

uricacid. Elevated phosphorus and uric acid levels can causecrystal formation in the renal tubules, impairing filtrationand leading to renal failure. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

3. Measure of adequacy of fluid replacement and kidneyfunction. Continued intake greater than output mayindicate renal insult/obstruction. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

4. Indirect indicators of fluid status/hydration. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

5. Affects intake, fluid needs, and route of replacement. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. Promotes urine flow, prevents uric acid precipitation, and enhances clearance of antineoplastic drugs. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Steady rehydration over time prevent peaks/ valleys in fluid

safety had been promoted

e) Wellness had been promoted.


(IV/PO, enteral feedings)

3. Provide foods and beverages with high fluid content (Increased OFI), and fluids containing electrolytes (e.g., Gatorade)

Dependent:1. Ondansetron Hydrochloride

(Zofran) 2mg SIVP q 12h RTC as administered by physician

2. Allopurinol (Zyloprim) 300mg P.O daily or divided t.i.d after meal. As administered by physician

3. Sodium Bicarbonate (NaHCO3) 50 meq plus D5 0.3% NaCl as administered by physician.

Collaborative:1. Administer IV fluids as

indicated

level. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

3. To promote rehydration (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. Anti-emetic, relieves N/V associated with administration of chemotherapy. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

2. Improves Renal excretion of toxic by products from breakdown of leukemia cells. Reduces the chances of nephropathy as a result of uric acid production. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

3. May be used to alkalinize the urine, preventing or minimizing tumor lysis syndrome/ kidney stones. (Jhonroks, Nusing Care Plan for Leukemias, Scribd, 17471597)

1. Maintain fluid/electrolyte balance in the absence of oral intake; prevents or minimizes tumor lysis syndrome, reduces risk of renal complication. (Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-


2. Laboratory Data:Hgb/Hct, electrolyte(sodium, potassium, chloride, bicarbonate); BUN, Creatinine.

d. To promote safety and comfort

Independent:

1. Bathe less frequently using mild cleanser soap and provide ptimal skin care with suitable emollients. Apply lotion / skin care if indicated.

2. Provide frequent oral and eye care.

3. Change position frequently,

4. Provide safety measure. Note: if patient is confused).

e. To promote wellness

Independent:

327).

2. As baseline data, to determine fluid and electrolytes loss. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

1. To maintain skin integrity and pevent excessive dryness. Skin Barrier. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

2. Prevent injury from dryness. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

3. To prevent decubitus ulcer and facilitate body fluid flow. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

4. To promote safety and security. .(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).


1. Discuss factors r/t occurrence of deficoit as individually appropriate.

1. Early identification of risk factors can decrease occurrence and severity of complications..(Nanda,2008. Defient Fluid Volume. Nurses Pocketbook. 11th Ed pg 320-327).

Nursing Care Plan AML

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