Acute Lymphoblastic Leukemia (ALL) SKINNY Reasoning ALL ANSWERS 100% CORRECT SPRING FALL-2022 LATEST SOLUTION GUARANTEED GRADE A+

Part 1: 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): o Cindy's pregnancy was uneventful and April was born via an uncomplicated vaginal delivery at 40 weeks and weighed 7 lbs., loz. (3.2 kg.) o Tonsillectomy at 3 years old under general anesthesia. o 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: 10-year-old female with acute lymphoblastic leukemia (ALL) She has been receiving chemotherapy since her diagnosis three months ago. She is two days out from her most recent chemotherapy treatment. It is important to know that the patient is 10 years old to adapt the plan of care to her stage of development. Knowing her cancer diagnosis of ALL is key to understanding that she is presenting as an emergent case and what nursing interventions are critical for a patient with ALL. Knowing she was only diagnosed 3 months ago is very important to note as she has not dealt with the disease very long, is currently undergoing chemotherapy and had her last treatment two days ago. This information can provide insight to what is causing her symptoms and what diagnostic testing should be done. Also, it tells us she is actively fighting the cancer and is not in remission, thus making her immunocompromised and susceptible to infections. ALL is characterized by cancerous cells in the bone marrow producing excessive amounts of immature white blood cells that can lead to damage in the circulatory system and in the organs of the body if levels are too high. Chemotherapy is used because it destroys the cancerous tissue. Unfortunately, it also affects healthy tissues/cells and reduces the white blood cell count, cancerous and healthy, until the immune system is no longer able to function efficiently to be able to fight off foreign bacteria and invading viruses. Temperature of 38.4 degrees C. (101.2 F.) and a complaint of a sore A temperature over 100.4 in pediatric patients with cancer is considered an emergency! Fever and sore throat are signs of throat. April's mother reports that her fever has been unresponsive to acetaminophen and 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 infection, reactions/side effects to chemotherapy. Chemotherapy often causes pain and irritation of various tissues, it causes patients to feel fatigue and malaise. An unresponsive fever despite interventions requires immediate intervention Knowing if the patient is experiencing nausea etc. is important to help the healthcare team distinguish the possible cause of the patient’s symptoms. Since ALL occurs with too many immature WBCs and life- threatening complications can occur, it is important to draw labs immediately and admit the patient. CBC, liver panels and other labs will give insight to her immune status, if she requires neutropenic precautions, if any of her organs are being affected by her chemotherapy and for signs of possible sepsis or cancer complications. Her CVAD will be used to reduce any new portals of infection and for efficiency as patients veins are difficult to start IVs with as their veins RELEVANT Data from Social History Clinical Significance: 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 57 lbs. (25.9 kg), is 51.5 inches (128.8 cm.) and has NKDA. Difficulty keeping up with school and not wanting to speak and see friends could indicate that April is struggling to adjust to her diagnosis and the symptoms that come along with ALL. Also, the side effects of chemo drugs likely affect her self esteem and she may feel depressed. Being around other children is very important for a child’s development socially and developmentally as their interaction with others allows them to learn more about interactions and how the world works. Without it, it places her at risk for delayed social development that will leave her possibly struggling with identifying and communicating with others now and in the future. Knowing her height and weight is important to calculate safe dosages of her medications as well as knowing if she has any allergies. Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment (5th VS): T: 100.8 F/38.2 C (oral) Provoking/Palliative : "My throat hurts" P: 112 (reg) Quality: "Bad" R: 24 (reg) Region/Radiation: Throat BP: 102/66 Severity: "I don't know." 02 sat: 96% on room air Timing: Ongoing What VS data are RELEVANT that must be recognized as clinical significance by the nurse? RELEVANT VS Data: Clinical Significance: T: 100.8 F/38.2 C (oral) Fever over 100.4 is dangerous, it is also a sign of infection/immune response. Fever is also a symptom of ALL and further diagnostic testing would be required to determine if the fever is occurring due to an infection or as a result of the cancer. P: 112 (reg) Pulse is elevated, could accompany fever. The patient is likely afraid, they feel ill and they have just been diagnosed with cancer and began undergoing chemotherapy. Chemotherapy suppresses all functions of the body and the production of WBCs and RBCs which affects both the immune system and the circulatory system. Anemia is a condition with less RBCs meaning that the body has less healthy hemoglobin to carry adequate oxygen to the body which would lead to an increased pulse and respiratory rate to compensate for the oxygen demands. Elevated RR corresponds with the tachycardia. Could be related to the fever or the patient’s possible anemia that is secondary to her cancer treatment suppressing her RBC production. Less oxygen carrying capacity would cause the body to compensate by moving the blood through the circulatory system faster to pick up oxygen and move it throughout the body fast enough to meet the demand. R: 24 (reg) The source of pain in the throat could indicate an infection, specifically a strep throat infection that is common among children. It is caused by the Streptococcus genus and is characterized by white exudate on the tonsils, mouth and throat. It is very painful and lymph nodes are commonly sore and swollen. It could have been an infection that could possibly have developed into a systemic bacterial infection. Possibly, she could have developed mucositis which is common with chemotherapy and occurs when tissue becomes inflamed and irritated and it may have become a portal of entry for the infection to take root and become strep throat, before entering the bloodstream. Likely is not suffering from decreased oxygen levels or any oxygen issues at this point in time. However, at 10 years old with no other respiratory issues she should have a O2 saturation near 100%. Having oxygenation at the lower end could be related to anemia secondary to her chemotherapy treatment. "My throat hurts" “Bad” Throat “I don’t know” ongoing O2 96% RA All of these VS data indicates an infection supported by pain in the throat. These are all significant findings for a patient with leukemia because classic signs of infection may be absent due to bone marrow suppression and infection is a major concern for a child receiving treatment for cancer. Current Assessment: GENERAL APPEARANCE: Resting in bed with eyes closed, pale in appearance. RESP: Breath sounds clear with equal aeration bilaterally, unlabored respiratory effort CARDIAC: Skin is pale, cool to touch. Cap. Refill 3-4 seconds in both hands. No edema noted, heart sounds regular with no abnormal beats, radial and pedal pulses present and strong. NEURO: Patient appears lethargic, drowsy, oriented x4. GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Last BM yesterday evening GU: Voiding without difficulty SKIN Skin integrity intact. Central venous access device (CVAD) in place, dressing intact What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?