Acute Lymphoblastic Leukemia (ALL) SKINNY Reasoning, April Peters, 10 years old Female with Acute Lymphoblastic Leukemia (ANSWERED).

Acute Lymphoblastic Leukemia (ALL) SKINNY Reasoning, April Peters, 10 years old Female with Acute Lymphoblastic Leukemia (ANSWERED). Acute Lymphoblastic Leukemia (ALL) SKINNY Reasoning April Peters, 10 years old Primary Concept Cellular Regulation Interrelated Concepts (In order of emphasis)  Infection  Perfusion  Clinical Judgment  Patient Education NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment  Management of Care 17-23%   Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12%  Psychosocial Integrity 6-12%  Physiological Integrity  Basic Care and Comfort 6-12%   Pharmacological and Parenteral Therapies 12-18%   Reduction of Risk Potential 9-15%   Physiological Adaptation 11-17%  © 2018 Keith Rischer/www.KeithRN.com SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data History of Present Problem: April Peters is a 10-year-old female with acute lymphoblastic leukemia (ALL) who presents to the emergency department with a temperature of 38.4 degrees C. (101.2 F.) and a complaint of a sore throat. She has been receiving chemotherapy since her diagnosis three months ago. April’s mother reports that her fever has been unresponsive to acetaminophen and she is two days out from her most recent chemotherapy treatment. No reports of nausea, vomiting, or diarrhea noted. A CBC is drawn immediately from April’s central venous access device (CVAD) and April is admitted directly to the pediatric oncology unit where you are the nurse responsible for her care. She weighs 57 lbs. (25.9 kg), is 51.5 inches (128.8 cm.) and has NKDA. Personal/Social History: April lives at home with her mother Cindy, her father Tom, and her 6-year-old sister Maggie. Tom works full-time as an engineer while Cindy stays home with the children because of April’s diagnosis and resulting hospitalizations and treatment. April has missed quite a few days of school. Although her school system has provided April with a tutor to keep up with her studies, April does not return telephone calls from her friends and refuses their visits. Past Medical History (PMH):  Cindy’s pregnancy was uneventful and April was born via an uncomplicated vaginal delivery at 40 weeks and weighed 7 lbs., 1oz. (3.2 kg.)  Tonsillectomy at 3 years old under general anesthesia.  ALL diagnosis 3 month ago following a short history of headaches and pallor. April’s WBC count at diagnosis was 469,000  FYI: Hyperleukocytosis is defined as a peripheral white blood cell count greater than 100,000/mm3 and is a pediatric oncologic emergency. These white blood cells are immature blast cells not normal cells. Hyperleukocytosis can progress to capillary obstruction, microinfarction, and organ dysfunction, which can lead to respiratory distress and cyanosis. Children may also experience changes in neurologic function, including an altered level of consciousness, visual disturbances, confusion, and ataxia. What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: She has been receiving chemotherapy for her diagnosis of ALL. Last treatment was 2 days ago. Fever of 101.2 F (38.4 C), unresponsive to acetaminophen at home. Complaint of sore throat Chemotherapy is the use of drugs to treat cancer. These high-risk drugs are administered and travel through the blood stream to destroy cancer cells throughout the body. Damaging side effects of chemotherapy must be considered. Elevated temp is a clinical RED FLAG and potential medical emergency. In a child with cancer, careful consideration must be given to any temperature greater than 100.4 F (38.4 C) because of the risk for immunosuppression and infection. Unlike other cancers, leukemia does not produce a mass, but results in the overproduction of immature white blood cells. Because of leukemia’s impact on the body’s infection-fighting cells, a child with leukemia is at a higher risk for developing infections. This complaint must be recognized by the nurse as a clinical RED FLAG and investigated further. Likely represents mucositis due to small ulcerations in the mouth and throat as a result of current chemotherapy and is an expected side effect. RELEVANT Data from Social History: Clinical Significance: She has been missing a significant amount of According to Hockenberry & Wilson (2014), school-age children rely on © 2018 Keith Rischer/www.KeithRN.com school due to her illness and has not been keeping in touch with her friends. peer relationships to provide security and comfort as they work to gain independence from their parents. Children who feel alienated from their peer group may experience depression, impaired social development, and poor school performance.