CASE 1

Course Assignment: Haematology and Immunology System

Compiled by:
Group 1-5

1. Umiyanah (012411001) 14. Tiara Husni (012411021)

2. Nadin Zafira Anastasya (012411002) 15. Khairunnisa Widiyastuti (012411024)
3. Jihan Almas Wahyuni W (012411003) 16. Salman Joan Rajendra (012411026)
4. Patma Sari Kartini (012411004) 17. Raden Andi Ramadani T. (012411037)
5. Amelia Mutiara Syuhada (012411006) 18. Nasywa Oktavia Sumarna (012411039)
6. Quentin Clarinet J.H. (012411008) 19. Kiswah Nul Fi’ili (012411045)
7. Muhammad Tioadzy P.A. (012411009) 20. Abd. Roni (012411046)
8. Galih Bayu Nur Anggitan (012411014) 21. Putri Cahya Anggraeni (012411048)
9. Wiwit Dinda Pratiwi (012411015) 22. Saihou Sissoho (012411052)
10. Faquita Handayani D (012411016) 23. Hasnan Ramadhan (012411054)
11. Theresia Tidore Hasiani S (012411017)
12. Ishom Isa Baraja (012411018)
13. Revalina Naysilla R (012411019)

BINAWAN UNIVERSITY
NURSING STUDY PROGRAM
JAKARTA
2025
 CASE 1

Managed Case
A 24-year-old male patient has been hospitalized in the Internal Medicine ward for the past 2
days with complaints of pain and fever.

Assessment results:
The patient complains of pain in the mouth, especially when chewing, mouth ulcers, nausea,
loss of appetite, weakness, blood pressure 120/75 mmHg, pulse rate 78 beats/minute,
respiratory rate 20 breaths/minute, temperature 37.5°C, and a history of bleeding gums.
The patient often asks why he frequently feels weak, easily fatigued, and reports having
difficulty sleeping at night.

Introduction:
Cancer starts from cells in body tissues. Leukemia differs from most other cancers, which
generally form tumors. Because leukemia results from the uncontrolled growth of blood cells,
this cancer can proliferate within the circulatory system. Leukemia is a disease characterized
by an increase in the number of white blood cells (leukocytes). This increase is rapid and
uncontrolled, and the white blood cells are abnormal. In a microscopic examination of a
peripheral blood smear, immature, large white blood cells with visible nuclei (megakaryocytes)
can be seen. Some experts refer to leukemia as a malignancy of white blood cells (Hematologic
Neoplasms). Under normal conditions, cells grow and die according to mechanisms regulated
by the body, so that old cells die and are replaced by young ones.
Leukemia occurs when the cell maturation process is disrupted, causing white blood cells to
become abnormal and undergo changes toward malignancy. These changes often involve the
rearrangement of parts of chromosomes (the cell's complex genetic material).

Types of Leukemia:
1. Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia or acute lymphoblastic/lymphocytic leukemia (ALL) is a type
of leukemia cancer that occurs when lymphoblasts (immature lymphocyte-type white blood
cells) produced by the bone marrow multiply too quickly, aggressively, and uncontrollably.
2. Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is a type of leukemia that occurs when the bone marrow
overproduces abnormal lymphocytes, which slowly and long-term develop into cancer.
3. Acute Myeloblastic Leukemia
Acute myeloblastic/myeloid leukemia (AML) is a type of leukemia caused by the
overproduction of immature myeloid cells (myeloblasts) in the bone marrow.
4. Chronic Myelocytic Leukemia
Causes Chronic myelocytic leukemia or chronic myelogenous/myeloid leukemia (CML) is a
type of leukemia in which the bone marrow produces excessive and uncontrolled amounts of
myeloid cells that develop slowly and over a long period of time (even up to years).
5. Hairy Cell Leukemia
Hairy cell leukemia is a rare type of chronic leukemia, but can usually be found in adults. This
type of leukemia is called hairy cell because the cells look like hair when viewed under a
microscope. It develops slowly and affects B lymphocytes.

Questions:
1. Are there any other assessment data needed for this patient?
Answer:
Yes, there are still other assessment data that we need, they are also quite important
and relevant. These may include:
• Complete Blood Call (CBC), this is essential because the patient complains of
weakness, fatigue, and bleeding gums. This can be a possible sign of anemia,
infection, or other blood disorders.
• Oral and Dental Examination, a detailed oral examination is crucial since the
patient experience mouth pain, ulcers, and gum bleeding.
• Nutritional and Vitamin Deficiency Assessment, Vitamin C or B12 deficiency
should be suspected and assessed due to loss appetite, fatigue, and mouth issues.
2. What are the nursing problems in this case?
Answer:

Number Nursing Etiology Supporting Data

Problems

1. Acute Pain Physiological injury Subjective Data:

(D.0077) agents (Inflammation
of the oral mucosa) • The patient complained
that his mouth felt sore.
• The patient said that the
pain had been there for 2
days.
• The patient said that the
pain appeared especially
when chewing and the
pain appeared because of
canker sores.

Objective Data:

• There are canker sores in

the patient's mouth.
• History: Bleeding gums.

2. Risk of Secondary immune Subjective Data: -

Infection deficiency:
(D.0142) Leukopenia. Objective Data:

• There are canker sores on

the oral mucosa
• History: Bleeding gums
• Body temperature: 37.5°
(mild fever)

3. Risk of Inability to swallow Subjective Data:

Nutritional food (Appetite ↓ due to
Deficits pain & nausea) • The patient complains of
(D.0019) pain when chewing
• The patient feels nauseous
 • The patient says he has no
appetite
• The patient says he often
feels weak and tired
quickly.

Objective Data:

• There are canker sores in

the patient's mouth.
• History: Bleeding gums.

4. Sleep Pattern Physical Conditions Subjective Data:

Disorders and Diseases • Patient complains of pain
(D.0055) • Patient admits to having
difficulty sleeping at night

Objective Data:

• Patient has a mild fever.

Subjective Data:
5. Fatigue Physiological
(D.0057) conditions (eg: mild • The patient said he often
fever, pain, mouth felt weak
ulcers, poor nutritional • The patient complained of
intake) getting tired quickly
• The patient said he had
difficulty sleeping at night

Objective Data:

• Body temperature 37.5°

(mild fever)
• Decreased appetite
• Canker sores & bleeding
gums (lack of nutritional
intake so weak -> fatigue)

6. Knowledge Lack of exposure to Subjective Data:

Deficit (D.0111) information • Patients always ask why
they often feel weak and
get tired quickly.

Objective Data: -
3. What are the appropriate nursing interventions, including monitoring, independent,
and collaborative interventions for this case?
Answer:

Number Nursing Diagnoses Interventions

1. Acute Pain (D.0077) Pain Management (I.08238)
Observation:
1. Identification of
location, quality,
intensity (scale 0-10),
duration of nonverbal
response pain,
triggering and
debilitating factors,
analgesic effects.

Therapeutic:
2. Non-pharmacological
techniques are applied:
local warm/cold
compressors,
aromatherapy, breath
relaxation.
3. Set the patient's
environment: low
light, minimal noise.
4. Facilitation of rest and
sleep.

Education:
 5. Explain the causes and
triggers of pain, teach
relaxation techniques,
use of independent
analgesics.

Colaboration :
6. Coordination of the
administration of
analgesics, and topical
antiseptics from the
doctor.

2. Risk of Infection (D.0142) Infection Prevention

(1.14539)

Observation:
• Monitor signs and
symptoms of local and
systemic infection (e.g.,
increased fever, redness,
pus in canker sores,
increased pain)

Therapeutic:
• Limit the number of
visitors (to reduce the risk
of exposure to new
microorganisms)
• Wash hands before and
after contact with patients
and the patient's
environment
• Maintain aseptic
techniques when treating
oral or mouth wounds

Education:
• Describe the signs and
symptoms of infection to
watch out for (fever,
purulent sores, odor,
increased pain)
• Teach how to wash your
hands properly
• Teach cough etiquette (use
tissues/elbows when
coughing/sneezing)
• Teach how to examine the
wound in the mouth (pay
attention to color, pain,
enlargement)
• Recommend increasing
your intake of nutrients
(soft, cold, non-spicy
foods)
• Recommend increasing
fluid intake to prevent
dehydration and support
immunity

Collaboration
• Collaboration in
immunization if needed
according to the patient's
 medical condition and
immunization history

3. Risk of Nutritional Deficits (D.0019) Eating Disorder

Management (I.03111)
Observation:

1. Monitor food and fluid

intake and output, as
well as calorie needs

Therapeutic:

2. Weigh the patient

regularly

3. Discuss eating
behavior and the
amount of physical
activity (including
exercise)
4. Make a behavior
contract (e.g., weight
target, behavior
responsibilities)

Education:

5. Teach proper diet

management
6. Teach coping skills to
deal with eating
behavior problems
 Collaboration:

7. Collaborate with a
nutritionist on weight
targets, calorie needs,
and food choices

4. Sleep Pattern Disorders (D.0055) Sleep Support (I.05174)

Observation:

1. Identify patterns of
activity and sleep
2. Identify factors that
disturb sleep (physical
and/or psychological)
3. Identify any sleep
medications being
used

Therapeutic:

4. Modify the
environment (e.g.,
lighting, noise,
temperature, mattress,
and bed)
5. Help reduce stress
before bedtime
6. Set a regular sleep
schedule
7. Perform procedures to
increase comfort (e.g.,
massage, positioning,
acupressure therapy)
 8. Adjust medication
and/or treatment
schedules to support
the sleep-wake cycle

Education:

9. Explain the
importance of getting
enough sleep during
illness
10. Encourage following
regular bedtime
routines
11. Recommend sleep
medications that do
not suppress REM
sleep
12. Teach about factors
that contribute to sleep
disturbances (e.g.,
psychological,
lifestyle, frequent shift
changes)
13. Teach autogenic
muscle relaxation or
other non-
pharmacological
techniques

5. Fatigue (D.0057) Energy Management

(I.05178)
Observation:
 1. Identify body function
disorders that cause
fatigue
2. Monitor physical and
emotional fatigue
3. Monitor sleep patterns
and hours
4. Monitor location and
discomfort during
activities
Therapeutic:
5. Provide a comfortable
and low-stimulus
environment (e.g.,
light, noise, visitors)
6. Give calming
distraction activities
Education:
7. Encourage bed rest
8. Encourage doing
activities gradually
9. Encourage the patient
to contact a nurse if
signs and symptoms of
fatigue do not decrease
10. Teach coping
strategies to reduce
fatigue

Collaboration:
11. Collaborate with a
nutritionist on how to
increase food intake,
 adjusted to the
patient's physical
condition
6. Knowledge Deficit (D.0111) Health Education (I.12383)

Observation:

1. Identify the patient’s

readiness and ability to
receive information
2. Identify factors that
may increase or
decrease anxiety about
the patient’s condition

Therapeutic:

3. Provide health
education materials
and media
4. Schedule health
education sessions
based on mutual
agreement
5. Give the patient the
opportunity to ask
questions

Education:

6. Explain the risk

factors that can affect
health
7. Teach clean and
healthy living
behaviors
8. Teach strategies to
improve clean and
healthy living
behaviors
Reference:

PPNI. (2022). Standar Diagnosis Keperawatan Indonesia (SDKI), Standar Luaran (SLKI),
dan Standar Intervensi (SIKI). Jakarta: Dewan Pengurus Pusat PPNI.

Dewi, R.A., & Yulianti, T. (2021). Asuhan Keperawatan pada Klien dengan Gangguan
Sistem Hematologi. Yogyakarta: Pustaka Baru Press.

Muttaqin, A. (2018). Buku Ajar Keperawatan Medikal Bedah: Sistem Hematologi &
Imunologi. Jakarta: Salemba Medika.

Kozier, B., Erb, G., Berman, A., & Snyder, S. (2016). Fundamentals of Nursing: Concepts,
Process and Practice (9th ed.). New Jersey: Pearson Education.