SOUTHVILLE INTERNATIONAL SCHOOL AND COLLEGES

1281 Tropical Ave. Cor. Luxembourg St. BF International, Las Piñas City, 1740

Student’s Name: Maria Victoria Praxides Date :10/6/2022

Year and Section: BSN 4B Subject: NCM 118
Clinical Instructor: Miss Jam Magno

CASE STUDY
(Leukemia)

Mr. Devito is a 48-year-old male who presents to his Primary Care Provider with
left upper abdominal pain and complaints of weakness and fatigue. The nurse
immediately notes how pale his skin is.  A full set of vital signs reveals the
following:
HR 82 bpm
BP 142/90 mmHg
RR 16 bpm
SpO2 94% on Room Air
Temp 101.0°F

Question 1: What further nursing assessments would you perform at this time?

Answer:

Mr. Devito complained about his left upper abdominal pain, weakness and fatigue.
He also has a pale skin that can indicate a low decreased blood supply to the
skin. The nurse also notes a palpable mass in the left upper quadrant that is
tender on palpation. It can be an indication of an enlarged spleen.The patient
says he seems to bruise easily this days. The nurse notes his bruising and
petechiae in Mr. Devito arms and legs which can be an indication of autoimmune
disorder which can be thoroughly detailed thru lab test. The patient’s lungs have
diffuse crackles, heart sounds S1 and S2 present with no murmurs. The patient
also reports a slight headache. He has a fever of 101.0°F which can be a sign of
infection. The elevated BP and low SpO2 should also be further assessed and
carefully monitored.

FURTHER ASSESSMENT:
- I would further assess his pale skin which can be an indication of poor
tissue perfusion, check Mr. Devito peripheral perfusion: his capillary
refill(<2 secs),Check for pallor and coolness.Inspect if there are wounds,
injuries,bruises taking longer time to heal which can be an indication of low
immune system. Re assess his vital signs BP,HR,PR,RR,SPO2 and LOC.
will thoroughly assess his pain using Pain Scale, check the skin and
mucous membranes such as edema, swelling,moist areas,excoriation and
lesions. Im gonna assess Mr. Dovito heart and lung sounds,check for the
presence of crackles,s1 and s2 heart sounds,murmur,bruits and respiratory
changes.
Upon further assessment, the nurse notes a palpable mass in the left upper
quadrant, possibly an enlarged spleen, that is tender on palpation. The nurse also
notes petechiae and bruising to the patient’s arms and legs. When questioned,
the patient says “I seem to bruise so easily these days”. The patient’s lungs have
diffuse crackles, heart sounds S1 and S2 present with no murmurs. The patient
also reports a slight headache.

Question 2: What laboratory or diagnostic tests do you anticipate the provider

ordering?

The provider orders a complete blood count, chemistry panel, and chest x-ray.
The chest x-ray shows the patient has a slight pneumonia. He is sent home with a
course of antibiotics while awaiting the test results.
The next day, the lab results show the following:
RBC 4.2 BUN 22
Hgb 8.4 Cr 0.9
Hct 25.2 K 3.9
WBC 144,000 Na 148
Plt 40,000 Ca 7.6

Answer:

● Due to the presence of fever, enlarged spleen, decrease tissue perfusion,

easily bruising and petechiae.The patients is showing the signs and
symptoms of leukemia It will be anticipated that the provider will order lab
test like (CBC) Complete blood count to determine his RBC,WBC and
platelet. His enlarged spleen,fever and decrease tissue perfusion also
indicates infection thats why blood test is essential. Splenomegaly may be
brought by infection which can effect the health cell in the blood.

● Due to the diffused crackles assessed from the lungs,the physician may
also order chest xray.
● Full blood chemistry tests give important information about how well a
person’s kidneys, liver, and other organs are working. An abnormal amount
of a substance in the blood can be a sign of disease or side effect of
treatment

● Coagulation tests measure your blood's ability to clot and how long it
takes.This is needed to check for presence of hemostatic derangement
leading to hypercoagulability. Studies showed that onset of leukemia is
strongly associated with hypercoagulability. In other words, it is connected
with easy skin bruising experienced by the patient that was mentioned
above.

Question 3: Based on the above lab results, what should the nurse be most
concerned about?

According to the lab results, the RBC, BUN, Cr, and K levels are within the normal
levels. However, the levels of Hgb, Hct, Platelet, and Ca are low, whereas the WBC
count and Na levels are elevated. As a nurse I should be most concerned about
the extremely high and low abnormal levels. The patient has extremely low
platelet that is risk for bleeding. He also has a low WBC which means he is
immunocompromised.

Question 4: What do you believe may be going on, physiologically, with Mr.
Devito?
Mr. Dovito signs and symptoms together with his diagnostic lab result indicates
presence of leukemia. He manifested symptoms which are the presence of fever,
complaints of weakness and fatigue, enlarged spleen upon palpation, easy
bruising, and presence of petechiae. The lab results may also provide suggestion
for possible Leukemia due to the low Hgb and Hct (anemia) and the extremely
high levels of WBC.

Question 5: What further diagnostic testing should be performed to confirm a

diagnosis?

The blood tests providing the results above only suggest the diagnosis of
Leukemia, however, to be able to really confirm it as a diagnosis, the physician
may order a needle biopsy and aspiration of the bone marrow to test for
Leukemia. Bone marrow aspiration and biopsy: this is to check presence of blast
cells (immature cells that are dividing) – which is the confirmatory test when
diagnosing for leukemia. Additional imaging assessmentlike skeletal x-rays to
help determine bone resorption. Chromosome analysis (cytogenic studies) to
help identify marker chromosomes.

Question 6: How would you explain this to the patient’s wife?

Mr. Devito will be started on high-dose chemotherapy.

The nurse should inform the wife about the illness process, available treatments,
side effects, and what to anticipate during the course of therapy when the
diagnosis has been confirmed. Since this is a difficult time for our patients, we
should advocate for them and their loved ones. They must learn to cope with the
stress which will undoubtedly have an impact on many aspects of their lives,
including their financial situation, psychological well-being, and the weight of
directly caring for a family member who has cancer.

Question 7: What education topics should be included in teaching for Mr. Devito
and his wife?

Regarding Mr. Devito's therapy, Health teaching education is really essential.

The significance of healthy eating, exercise and self care. Teach the patient what
to expect after chemotherapy, how to manage side effects of the
treatment such as mouth sores, upset stomach and diarrhea and supporting them
emotionally. Additionally, because chemotherapy medications are regarded as
cytotoxic. Nursing professionals should review
safely managing chemotherapy medications with the patient before discharge.
Adding emphasis conventional safety precautions since these medications are
cytotoxic: both have cancer-causing properties
teratogenic outcomes (damages ovaries and testicles causing infertility)
Educate the patient to prevent any kind of infection: safe eating and drinking
during cancer treatment and frequent hand washing
Teach other self-care measures: staying active, eating healthy, caring for PICC
line (if present) and avoid smoking.