Palliative Care for Bleeding and Bruising in Leukemia Patients

This report discusses the management of bleeding and bruising in leukemia patients through palliative care. It covers the impact of this symptom on patients and their families, and the social and cultural issues that may arise. The report also includes information on the illness and related symptoms, assessment tools, and nursing management goals.

Running head: PALLIATIVE CARE
PALLIATIVE CARE
Name of the Student
Name of the university
Author’s note

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1. Illness and the related symptoms
The terminal illness that has been chosen for this report is cancer. Cancer is caused due to
the abnormal multiplication of the cells induced by a genetic change (Davis et al. 2014). The
uncontrolled division of the cells leads to formation of a mass of cells called the tumor. A
tumor can be cancerous or benign. As a cancerous tumor grows, the cancer cells can be
carried by the blood system and the lymphatic system to other parts of the body. During the
process of metastasis the cells grow and develops in to new tumors (Davis et al. 2014). The
first place to which the cancer spreads are the lymph nodes. Some of the common signs and
symptoms related to leukemia re persistent fatigue, easy bleeding or bruising, nosebleeds and
recurrent, persistent fatigue and weakness, excessive loss of weight, swelling of the body.
2. One of the signs of leukemia is easy bleeding or bruising.
One of the important assessment tool is the needle biopsy to confirm the disease. In a
needle biopsy, a long and a rigid needle is inserted into the bone marrow and the cells are
aspirated for the study. The cells are then observed for checking the signs of cancer. It is
also due to the excessive low platelet count in the cancer patients (Choudhry &
DeLoughery 2012). The platelets present are not enough to plug the damaged blood
vessels.

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3. Management of bleeding and bruising in leukemia patients:-
Nursing management of the leukemia patients includes proper assessment of the signs
and the symptoms, such as assessing the health history, physical examination of the
patient y the systemic assessment of the body system. The nurse should educate the
patient and the family about the recognition of the abnormal bleeding through bruising
and petechiae and the way to cease it with direct pressure. Other nursing management
goals are the monitoring of the vital signs if the bleeding persists as hypovolemic shock
can occur due to the decreased circulatory volume (Jabbour & Kantarjian, 2012). It is
essential to monitor the hemoglobin and the hematocrit levels as the indicators of blood
loss. Clients who need frequent blood transfusions may develop inhibitor antibody and
hence require an alteration in the coagulation therapy. Blood cell growth factor can be
prescribed to the patients suffering from bleeding and bruising (Choudhry & DeLoughery
2012). Other treatments that can be given to the patient is platelet transfusions and
admission to the hospital unless the platelet returns to the sufficient levels. Other
management of the bruising and bleeding involves application of cold compress as it
would decrease the inflammation of the injured area and limits swelling. The area of the
bruising should be elevated above the level of the heart. It is also necessary to check the
medications as a medications in cancer interferes with the clotting of the blood.
4. Impact of the symptom on patients and their family
This symptom of the patient can be detrimental if the amount of bleeding is high
as it can cause hypovolemic shock and the patient can get traumatized. Cancer itself is a
disease that brings with excessive physical burden as well as psychosocial burden (Bruera
&Yennurajalingam 2012). Bruising or bleeding can bring about mental and financial

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burden in both the patient and the family. Most of the time they are filled with
uncertainty and fear. The patient and the family experiences high level of distress may be
due to the wide burden of the treatment options, tests, medicines and ling hospital stays
(Northouse et al. 2013). Furthermore the increased dependence of these patients can bring
about distress in the family and the terminally ill patient might have a feeling of
helplessness of anxiety in the patient. Bruising in the patient may develop fear among the
family members about handling of the patient as a slight pressure may cause bruising
(Walter & Estey 2015). Since most of the palliative care patients are elderly patients,
hence there is a chance of bleeding from the pressure ulcers. Extra care has to be taken
for managing the bleeding that can be distressing to the patient.
Communication is the core concept of nursing. A good communication with the patient
and the family can improve the wellbeing of the palliative care patients (Dean & Street
2014). Communicating regarding the concerns and the decision making in patients can build
a trusting relationship between the patient and the caregivers as it helps to understand the
grievances of the patients. Communication is necessary for educating the family about the
ways to manage bruising in patients, proper ways to apply compress or education about the
patient care regimen.
5. Social and the cultural issues:-
It should be mentioned that management of the bleeding and bruising in elderly people
require delicate handling of the patient and requires training. A patient belonging to a diverse
cultural background might not find it comfortable to be touched by an opposite gender caregiver,
which can act as a barrier to the nursing care. There is a religious group of people such as the

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Jehovah’s witnesses that refrain from blood transfusion or any components of blood including
the platelets. Such religious beliefs can hinder the provision of care to the patients.
Cancer care is complex and an effective interdisciplinary team is necessary to improve
the communication, decision making and coordination between the health care professionals.
Furthermore each of the professionals can apply their own skills for improving the patient
outcome, by using the various care models (Holloway et al. 2014).

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References
Bruera, E. &Yennurajalingam, S., 2012. Palliative care in advanced cancer patients: how and
when?. The oncologist, 17(2), pp.267-273.
Choudhry, A. & DeLoughery, T.G., 2012. Bleeding and thrombosis in acute promyelocytic
leukemia. American journal of hematology, 87(6), pp.596-603.
Davis, A.S., Viera, A.J. and Mead, M.D., 2014. Leukemia: an overview for primary care. Am
Fam Physician, 89(9), pp.731-738.
Dean, M. & Street, R.L., 2014. A 3-stage model of patient-centered communication for
addressing cancer patients’ emotional distress. Patient education and counseling, 94(2), pp.143-
148.
Holloway, S., Lord, K., Bethelmie-Bryan, B., Shepard, M.W., Neely, J., McLemore, M., Reddy,
S.K., Montero, A., Jonas, W.S., Gladney, S.P. & Khanwani, S.L., 2012. Managing chronic
myeloid leukemia: a coordinated team care perspective. Clinical Lymphoma, Myeloma and
Leukemia, 12(2), pp.88-93.
Jabbour, E. & Kantarjian, H., 2012. Chronic myeloid leukemia: 2012 update on diagnosis,
monitoring, and management. American journal of hematology, 87(11), pp.1037-1045.
Northouse, L., Williams, A.L., Given, B. & McCorkle, R., 2012. Psychosocial care for family
caregivers of patients with cancer. Journal of Clinical Oncology, 30(11), pp.1227-1234.

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Walter, R.B. & Estey, E.H., 2015. Management of older or unfit patients with acute myeloid
leukemia. Leukemia, 29(4), p.770.