Pediatric Acute Lymphoblastic Leukemia Questions and Answers 2022

Running head: CASE STUDY
CASE STUDY
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CASE STUDY
1
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

CASE STUDY
2
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.