PEDS LAB CASE STUDY
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.
, PEDS LAB CASE STUDY
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
- Patient is a 10 year old Patients have a type of cancer that affects the
female bone marrow and blood that affects WBCs. A
- Patient has Acute temperature and sore throat that isn’t getting
lymphoblastic leukemia relieved by acetaminophen can indicate
(ALL) infection which is very dangerous in a
- She has a temperature of cancerous patient. Her chemo treatment two
38.4 degrees celsius (101.2 days ago could have caused some side effects
degrees Fahrenheit) which are relevant to her history but she isn’t
- Presents with sore throat experiencing any nausea, vomiting, or
- Fever isn’t responding to diarrhea.
acetaminophen
- She had a chemo treatment
two days ago
- No nausea, vomiting, or
diarrhea
- She weighs 57 pounds
- She is 51.5 inches tall
- Has no known allergies
RELEVANT Data from Social Clinical Significance:
History:
- Lives at home with mother, Her mother staying home with her is
father, and 6 year old definitely supporting her diagnosis and
sibling helping her transition to an ill child. Her
- Her dad is a full-time receiving tutors will help get through all her
engineer and her mother school work. Her denying friends and not
stays at home to care for her responding to their phone calls should be
- She receives tutoring at brought up and discussed. She may be
home for missing school embarrassed by the way she looks and she
- She denies her friends to shouldn’t be, her friends are there to support
come visit her and doesn’t her, not judge her.
return their phone calls.
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.
, PEDS LAB CASE STUDY
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
- Patient is a 10 year old Patients have a type of cancer that affects the
female bone marrow and blood that affects WBCs. A
- Patient has Acute temperature and sore throat that isn’t getting
lymphoblastic leukemia relieved by acetaminophen can indicate
(ALL) infection which is very dangerous in a
- She has a temperature of cancerous patient. Her chemo treatment two
38.4 degrees celsius (101.2 days ago could have caused some side effects
degrees Fahrenheit) which are relevant to her history but she isn’t
- Presents with sore throat experiencing any nausea, vomiting, or
- Fever isn’t responding to diarrhea.
acetaminophen
- She had a chemo treatment
two days ago
- No nausea, vomiting, or
diarrhea
- She weighs 57 pounds
- She is 51.5 inches tall
- Has no known allergies
RELEVANT Data from Social Clinical Significance:
History:
- Lives at home with mother, Her mother staying home with her is
father, and 6 year old definitely supporting her diagnosis and
sibling helping her transition to an ill child. Her
- Her dad is a full-time receiving tutors will help get through all her
engineer and her mother school work. Her denying friends and not
stays at home to care for her responding to their phone calls should be
- She receives tutoring at brought up and discussed. She may be
home for missing school embarrassed by the way she looks and she
- She denies her friends to shouldn’t be, her friends are there to support
come visit her and doesn’t her, not judge her.
return their phone calls.
