Care Study

I. INTRODUCTIONGenerally, leukemia means cancer of the blood that starts normally but begins to change and grow uncontrollably. Ii is called acute because of the sudden and quick occurrence and lymphiocytic because it obviously affects the lymphocytes hat has a greater role in the immune system of a person. Healthy lymphocytes fight bacterial and viral infections. In people with ALL, new lymphocytes do not develop into mature cells, but stay as immature cells called lymphoblasts. There are three different types of lymphocytes: T cells, B cells, and natural killer (NK) cells. Generally, T cells fight infections by activating other cells in the immune system and by destroying infected cells, B cells make antibodies, and NK cells fight microbes and cancer cells. About 85% of people with ALL have the B-cell subtype and about 15% have the T-cell type. The NK-cell subtype is quite rare.

shows estimated incidence (age-standardized on the world population) of leukaemia in children aged under 15 years for those countries of the European Region with population-based data available for years around 2000 (1–5). The average age-standardized incidence in participating areas was 46.7 cases per million per year. National estimates ranged from 35 cases per million per year in Israel to 60 cases per million per year in Italy and Malta. (WHO, 2009)

Philippines: leukemia ranks fifth in over-all mortality. It is the fourth leading cause of death among Filipino males, and sixth among Filipino females. According to data from the DOH, leukemia is among the top three cancer killers of Filipino males from 1991 to 1995, along with lung and liver cancers.

From 1993 to 1995, the incidence of leukemia was at 6.6 per 100,000 Filipinos. Leukemia is also the leading cancer among children ages 0-14, comprising 47.8% of all cases among boys and 48% among girls.

Region X – (malignant Neoplasm) (DOH Phil; selected causes of death) rank 9 on the list- 1,124 (2006)- 1,095 (2005)- 1,020 (2004)- 983 (2003)- 848 (2002; lungs)- 803 (2001; lungs)

II. ASSESSMENT

A. SOCIO-DEMOGRAPHIC DATA

This is a case of 15 year old Male Filipino student. He is the only son. Patient X

is a junior student from a Prestigious School in the city. Patient X was admitted last

February 12, 2013 for the first time at Capitol University Medical City. Patient X’s current

weight is 48.75 kg and stands 5’6” tall. He has no known family history of Cancer of any

type.

Vital Signs

Vital signs Day 1 Day 2 Day 3

BP 100/60

mmHg

100/60

mmHg

100/70

mmHg

Pulse Rate 89 bpm 92 bpm 91 bpm

Respiratory

Rate

28cpm 32cpm 18 cpm

Temp. 36.5 ˚C 36.7 ˚C 36.6 ˚C

O2 sat. 97 % 90% 96%

Chief Complaint

Patient X was brought to the hospital due to exertional dyspnea and easy

fatiguability.

History of Present Illness

Patient was generally well until 2 months prior to admission noted progressive

pallor which started from the nail beds that progresses to other parts – no consultation

was done. A week before the admission while on a strenuous activity, teachers and

classmates noticed that patient was generally pallor. Patient also complained of

shortness of breath and easy fatigability thus, brought patient to CUMC ER.

General Appearance

Upon assessment, patient X was conscious and responsive but was generally

weak and pale. He can answer to questions appropriately without any delay but

confessed he easily get tired. He’s hooked with PNSS 1L @ KVO rate infusing well at

the left arm. He’s also given oxygen inhalation at 4LPM via nasal cannula.

B. NUTRITION AND METABOLIC PATTERN

Pre-hospitalization: Patient X eats three times a day, and if by chance he grabs

ample time to eat snacks in between meals as long as he’s not busy in school. He

consumes ½-1 cup of rice every meal with his desired viand in a fair appetite.

During hospitalization: Patient X has fair appetite consuming only half of share.

He was advised to eat food that are nutritious for strong immune system.

Together with medical history, the physical examination aids in determining the

correct diagnosis and devising the treatment plan. This part of the study will present the

normal and regressed health function of Patient X pointing out the salient,

manifestations of the disease.

HEAD

Day 1 Day 2 Day 3

Head Normocephalic Normocephalic Normocephalic

Facial

movement

Symmetrical Symmetrical Symmetrical

Fontanels Closed Closed Closed

Hair Fine; evenly

distributed

Fine; evenly

distributed

Fine; evenly

distributed

Scalp Clean Clean Clean

EYES

Day 1 Day 2 Day 3

Lids Symmetrical Symmetrical Symmetrical

Peri-orbital

region

Normal Normal Normal

Conjunctiva Pale Pale Pale

Cornea &

lens

Opacity to

Right

Opacity to

Right

Opacity to

Right

Sclera Anicteric Anicteric Anicteric

Pupils Equal size:

3mm; brisk

reaction to

light; uniform

accommodatio

n

Equal size:

3mm; brisk

reaction to light;

uniform

accommodation

Equal size:

3mm; brisk

reaction to light;

uniform

accommodation

Visual

acuity


Peripheral

vision


EARS

Day 1 Day 2 Day 3

External

Pinnae

Normoset Normoset Normoset

External

canal

No abnormal

discharges

No abnormal

discharges

No abnormal

discharges

Tympanic

membrane

Intact Intact Intact

Gross

hearing


NOSE

Day 1 Day 2 Day 3

Septum Midline Midline Midline

Mucosa Pinkish Pinkish Pinkish

Patency Both patent Both patent Both patent

Gross

Smell


Sinuses No tenderness No tenderness No tenderness

MOUTH

Day 1 Day 2 Day 3

Lips Pale Pale Pale

Mucosa Pallor Pallor Pallor

Tongue Midline Midline Midline

Teeth Complete teeth Complete

teeth

Complete teeth

Gums Pale Pale Pale

PHARYNX

Day 1 Day 2 Day 3

Uvula Midline Midline Midline

Tonsils Not inflamed Not inflamed Not inflamed

Posterior

pharynx

Not inflamed Not inflamed Not inflamed

NECK

Day 1 Day 2 Day 3

Trachea Midline Midline Midline

Thyroids Non-palpable Non-palpable Non-palpable

SKIN

Day 1 Day 2 Day 3

General

color

Pallor Pallor Pallor

Texture Wrinkled Wrinkled Wrinkled

Turgor Normal Normal Normal

Temperatur

e

Warm Warm Warm

ABDOMEN

Day 1 Day 2 Day 3

General Superficial Superficial Superficial

Configuration Flat Flat Flat

Bowel

sounds

Normoactive Normoactive Normoactive

Percussion Tympanitic Tympanitic Tympanitic

CARDIOVASCULAR

Day 1 Day 2 Day 3

Point of

maximum

impulse

5th intercostal

space; left

midclavicular.

5th intercostal

space; left

midclavicular.

5th intercostal

space; left

midclavicular.

Heart

sounds

Regular Regular Regular

Peripheral

pulses

Regular; 89

bpm

Irregular; 92

bpm

Irregular; 96

bpm

Capillary

refill

2 seconds;

Normal

2 seconds;

Normal

2 seconds;

Normal

RESPIRATORY STATUS

Day 1 Day 2 Day 3

Breathing

pattern

Irregular;

28cpm

Irregular;

32cpm

Regular; 18

cpm

Shape of

chest

AP: 1:2;

Normal

AP: 1:2;

Normal

AP: 1:2; Normal

Lung

expansion


Vocal/tactile

fremitus


Breath

sounds


Cough None None None

BACK AND EXTREMITIES

Day 1 Day 2 Day 3

Range of Full Full Full

motion

Muscle tone

and

strength

Symmetrical

in size; 5/5

Symmetrical

in size; 5/5

Symmetrical in

size; 5/5

Spine Spine is

midline.

Normal

Spine is

midline.

Normal

Spine is

midline.

Normal

Gait Normal Normal Normal

C. ELIMINATION PATTERN

Pre –hospitalization and During hospitalization:

There are no significant changes in the bowel movement of the patient. He usually

defecates once a day usually early morning. Patient also urinates 6-10 times daily

approximately 200-350 per micturition.

D. ACTIVITY-EXERCISE PATTERN

Pre-hospitalization: The patient is an active varsity player at school. In fact, he’s

one of the best basketball players in the campus. He occasionally does chores at home

and helping his mom to get the work easily done.

During hospitalization: Because of easy fatigability and exertional dyspnea, he

cannot performed strenuous activities like playing.

E. COGNITIVE-PERCEPTUAL PATTERN

Patient X speaks Cebuano-Visayan language. He has no learning difficulties as

evidenced by comprehension of the nature of his condition. Intact remote and recent

memory. He was conscious, able to understand and can follow on whatever the nurses

teach her regarding her health.

G.SELF-PERCEPTION AND SELF-CONCEPT PATTERN

Patient X verbalized that he has many friends at school and usually spend time

playing basketball. He sees himself as a loyal friend to al his classmates. In fact, he was

very glad when all of his classmates visited him in the hospital.

H. ROLE-RELATIONSHIP PATTERN

Pre-hospitalization and during hospitalization: Patient X has a good and

sound relationship with his mother. And it got even tighter when he was hospitalized. It’s

his family that supports him emotionally and financially. Their primordial concern is his

fast recovery and resumption of his studies. Though explained the nature of the

disease, the mother is still hopeful for the recovery of his son which inspire patient to

fight.

J. COPING -STRESS TOLERANCE PATTERN

Pre-hospitalization: Patient X manages his condition by doing different kinds of

diversional activities like watching tv and playing basketball.

During Hospitalization: Patient X was worried about his condition but he can

control his anxiety through diversional activities, visitation from friends and prayers.

H. VALUE -BELIEF PATTERN

Patient X is a Roman Catholic. According to him, he goes to church every

Sunday and he does the rosary as part of their religious practices. Hospitalization does

interfere with his religious activities like going to church but he’s constantly praying even

hospitalized.

III. PATHOPHYSIOLOGYIV. TREATMENTV. NURSING CARE DONE

a. Risk for Infectionb. Activity Intolerance related to impaired exchange between oxygen and carbon dioxidec. Low Self Esteem related to the disease condition

VI. HEALTH TEACHINGA. Boosting Oxygenation and Promoting Activity

1. Avoid strenuous activities2. Perform activities with intervals and with rest periods.3. Avoid activities that are not purposeful.

B. Avoiding Infection1. Wash hands regularly.2. Avoid crowded places. 3. Take vitamins regularly.4. Inform AP ASAP for occurrence of fever.

Care Study

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