Pediatric Acute Lymphoblastic Leukemia Questions and Answers 2022

Running head: CASE STUDY
CASE STUDY
Name of Student:
Name of University:
Author’s Note:

1CASE STUDY
Answer number 1.
In the case study, Elodie Greer was reported with acute lymphoblastic leukaemia and had
undergone chemotherapy seven weeks before. However, she was admitted to the hospital in the
emergency department as she was feeling malaise and unwell. On assessment, it was reported
that she had developed sepsis secondary to an infected Hickman’s line. The two sign and
symptoms associated with the pathophysiology of the septic shock, which demonstrates clinical
deterioration are increased heart rate and respiratory rate. According to the study of
Shashikumar et al. (2017, pp 739-743.), it was reported that in sepsis, there is release of
inflammatory mediator like TNF-α, interleukin (IL) 1β, IL-6, and IL-8, and lead to myocardial
suppression. It causes release of nitric oxide which is vasodilator and cause increase in blood
volume and high contraction of left ventricle. This causes increase in heart rate (Borthwick et al.,
2017, pp 12-15). Due to slow circulation and high heart rate inadequate amount of blood is
transported to the lung, which causes the rate of respiration to increase. Oxygen is unable to
reach the lungs and alveoli due to which causes shortness of breath and high respiratory rate
(Wang et al., 2016, pp 1788-1793). It is noted in the case study that RR in patient was
21breath/min and oxygen saturation levels to 91% which have the potential to cause slow
metabolism of the body. Such sign is observed in Elodie needs consideration and effective
nursing intervention.
Answer number 2.
From the review of the case study, the priority problem associated with the clinical
presentation of the patient is decreased oxygenation. According to the study of Deschamps et al.
(2016, pp 826-836.), the normal oxygen saturation level is 95% to 100%, and the level below

2CASE STUDY
95% indicate the prevalence of hypoxemia. On assessment, she has been reported with a low
blood oxygen level and showed SpO2 of 91%. The problem of decreased oxygenation is the
clinical priority because it can cause slow circulation of blood and insufficient flow of oxygen in
the body (Pannu, Dziadzko & Gajic, 2016, pp e1-e5). It is seen in the case study that the patient
is having lymphoblastic leukaemia and is suspected with Hickman line infection and sepsis.
According to the review of Greco et al. (2017, pp 2200) it can be inferred that in the situation of
sepsis, there is various complication like the emergence of the blood clot and failure of vital
organs like heart, lungs and kidney. The clot blocks the flow the blood and oxygen to the vital
organs, which in turn impairs its metabolism. Thus, this leads to low oxygen saturation level.
Zeng et al. (2016, pp 1550-1554) have reported in his research that due to low oxygenation level,
the blood travels to the left side of the heart without carrying oxygenated blood and cannot reach
to the cells of the body. Thus, its diffusion into the bloodstream becomes impaired. As a result of
such, the vital organs become deprived of oxygen and tends to lose its functions. It increases the
incidence of asthma, shortness of breath and anaemia. From the research of Rivers et al. (2015,
pp 381-387) it can be said that low oxygen level in the blood has the potential to slow the
recovery process of the sepsis, moreover can also lead to elevated infection. It is seen in the case
stud that Elodie is suspected with Hickman’ sepsis, thus decreased oxygen level can slow the
recovery process and even elevate the infection. In the study of Pancholi et al. (2016, pp 565-
569), it has found that in the mechanism of Hickman's sepsis, low level of oxygen increases the
growth of infection. Due to the low saturation of oxygen, the immune response becomes
impaired, and there is a low level of the antibacterial mediator, which could increase the growth
of bacteria.

3CASE STUDY
Further, the issue of low oxygenation as the priority problem can be related by the study
of Stéphan et al. (2015, pp 2331-2339) where it is indicated that due to decreased oxygenation,
the function of the heart become slow leading to high blood pressure. Such a sign is observed in
the patient with a blood pressure of 103 beats/min. Thus, it can also lead to heart failure. From
the information gathered, it can be said that the problem of decreased oxygenation is the clinical
priority and need to take immediate and relevant intervention to address it.
Answer number 4.
The psychosocial issue identified by the review of the case study is anxious and stressed
the attitude of Elodie’s mother. On her visit in the evening, she appears to be worried due to the
health complication of Elodie. Such behaviour can have a negative impact on the health and
mental status of Elodie, as she needs strong support and care from her mother to cope with the
illness. It is evident from the research of Kazak et al. (2017, pp 1.) that patient and their family
facing psychosocial issue needs patient-centred care which can address their problem for health
promotion and wellbeing of the patient. It is the responsibility of the nurse to give support and
motivation via patient-centred care of healthy outcome of the patient and their family (Feo &
Kitson, 2016, pp 1-11). The nurse, with the skill of effective communication, can try to
acknowledge the psychosocial issue of the family. The nurse needs to provide counselling where
she will assess the desire and choice of the patient regarding the treatment. They will also be
given respect and care in consideration of the patient and their family. They will be included in
the decision making about their health and treated with dignity. This will help to build a trustful
therapeutic relationship and improve the mental stability of both patient and family (Richardson,
Percy & Hughes, 2015, pp e1-e5). The nurse will teach the family about the ways to cope with
the illness and make them understand the importance of handling the situation without being

4CASE STUDY
stress and anxiety. She will also provide them with strategies through which the patient and
mother can adequately handle the situation, thus as a consequence can lead to good quality of life
of the patient.

5CASE STUDY
Reference
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(2016). Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation
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Pannu, S. R., Dziadzko, M. A., & Gajic, O. (2016). How much oxygen? Oxygen titration goals
during mechanical ventilation.

6CASE STUDY
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