Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 Case Study 8 week 8.
- Institution
- William Paterson University
NUR 6111 Adv Nursing Practice 1
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Case Study#8 Answer-Please explain you answerA 12-year-old girl is taken to a walk-in clinic in her neighborhood drug store for a sore throat and fever.
The mother states that the child has been just lying around and is having her period. The girl reports that
she has had two periods in the past month and has to change her sanitary pad every couple of hours.
The clinician notes several bruises, and the girl does not remember how she got them. After speaking
with a colleague, the clinician advises the mother to take the girl to a local children’s hospital to be
evaluated. Later that day, the girl is diagnosed with ALL and begins chemotherapy.
All leukemias have certain pathophysiologic features in common. These include:
1. Increased function of granulocytic-monocytic cells
2. Increased function of bone marrow to fight the leukemic cells
3. Overcrowding of the bone marrow
4. Decreased response to biologic response modifiers
Answer: All leukemias have certain pathophysiologic features in common. These include uncontrolled
proliferation of malignant leukocytes and overcrowding of the bone marrow, causing a decreased
production and function of other blood cell lines. The granulocytic-monocyte, lymphocytic, and other
cells stop functioning.
While undergoing treatment, the girl becomes increasingly neutropenic and is unable to fight off an
infection. Overwhelming sepsis occurs, and the girl develops hypotension and shock. As a result, she
acquires DIC and multiple organ failure.
DIC is secondary to a wide variety of well-defined clinical conditions, specifically those that activate the
clotting cascade. The clotting may result in the consumption of platelets, and clotting factors may lead to
severe bleeding that is caused by:
1. Endothelial damage
2. Lack of thrombin production
3. Increased synthesis of thrombomodulin
4. Platelet activation
Answer: Endothelial damage results in the release of tissue factor that promotes the development of
thrombi. In DIC, thrombin production is persistent along with synthesis of thrombomodulin decreasing.
There is ongoing activation of clotting and too much thrombin being produced resulting in difficulty for
the body’s naturally occurring anticoagulants to regulate it.
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