Case Study: Ashlee Client profile: Ashlee is a 4-year-old…

Question Case Study: Ashlee Client profile: Ashlee is a 4-year-old… Case Study: AshleeClient profile: Ashlee is a 4-year-old preschooler who lives with her parents and two older siblings in a suburbanenvironment. She attends preschool five mornings a weekand enjoys playing with her 5-year-old sister and 7-year-old brother. She is very active and enjoys playing outside, riding her tricycle, climbing on the family’s jungle gym, and playing on the swing set. Her vocabulary consists of approximately 1500 words and she speaks using four – or five-word sentences. Her parents are very attentive to their children and spend each weekend doing ‘family activities.’ During the week, her parents work, and Ashlee and her siblings stay with their grandmother after school. Their grandmother lives in the same neighborhood. In the evenings, the family eats together and maintains an evening schedule that allows for family playtime.Case Study: During the past two months, Ashlee has been less active than usual and has begun taking one ortwo naps in the afternoon. Her grandmother and parents think she looks pale, reasoning that it is because of her high activity level, until her interest in going outside to play decreased dramatically. When they take her temperature, it is elevated, so they administer acetaminophen without effect. At this point, they decide to take her to see her pediatrician.Although the health care provider found Ashlee’smanifestations consistent with an upper respiratoryinfection, Dr. Polster is concerned and decides to admit Ashlee to the hospital for tests to rule out leukemia.Admission orders include: IVF 5 ½ + 30 mEq NaCO3/L (you will figure out the rate). Vital signs q 4 hours. Strict I&Os. Labs…and Chest X-RayAshlee is 38 lbs (17.2 kg) and 39 inches (99 cm). Body Surface Area 0.67. She has NKA. Her admission vitals are: Temp 38° C (100.4 °) HR 120 RR 28 B/P 100/60 Pain 3/10 on FLACC scale O2 Sats 100% on R/A. Her admission blood count shows: Hemoglobin: 7.5 g/dl, Hematocrit: 25 %, White Blood cell count: 25,000, Platelet count: 9,000Questions:1. What diagnostic tests would you expect to be orderedfor Ashlee?           Her admission blood count shows:Hemoglobin: 7.5 g/dlHematocrit: 25 %White Blood cell count: 35,000Platelet count: 9,000     2. The tests confirm a diagnosis of acute lymphocytic leukemia. Compare the two most common types of childhood leukemia (ALL and AML)    3. Ashlee’s mother is at Ashlee’s bedside crying. As you approach her, she says, “I didn’t have the money to take her to her 4-year-old check-up until 4 months after her birthday. If I’d taken her on time, would they have caught it earlier?” How would you respond to Ashlee’s mother?  4. Ashlee needs to start hydration at 2x maintenance. What should her IVF rate be?   Daily Maintenance Fluids CalculationWeightFluid Needs per 24 hours0 to 10 kg100 ml/kg11 to 20 kg1000ml + 50ml/kg> 20 kg1500 ml + 20ml/kg  5. Discuss the factors that affect Ashlee’s prognosis.    6. Discuss the common complications (adverse effects) of chemotherapy.   Ashlee went into remission after her first two weeks of chemotherapy. She has continued to receive chemotherapy according to the protocol on which she is enrolled. She was in her usual state of health until one week after her last round of chemo. Ashlee’s mother calls to say she has a fever of 38.6° (101.5° F). Ashlee is admitted into the hospital.Blood cultures are drawn via her implanted port catheter and a peripheral stick. Her admission labs show a WBC 0.03 Hemoglobin 6.8 Hematocrit 18.2 and platelet count 5. She is complaining of abdominal pain. Her Absolute Neutrophil Count (ANC) is 32. Her blood chemistries are WNL. She has no obvious sign of infection, but she’s had little appetite and threw up twice prior to admission. Her vitals on admission are Temp 39.2° HR 136 RR 32 B/P 112/68 Pain Score 6/10 on FLACC Scale O2 Sats 98% on R/A.Lab Results NormsResultsWhite Blood Cell Count5-10 mm30.03 mm3Hemoglobin10-15 gm/dl6.4 gm/dlHematocrit32-44%18 %Platelets150-400 mm35 mm3Absolute Neutrophil Count (ANC) 32Sodium3.4 – 4.7 mEq/L137 mEq/LPotassium135 – 145 mEq/L3.2 mEq/LChloride90 – 100 mEq/L100 mEq/LCarbon Dioxide22-30 mEq/L20 mEq/LGlucose70 – 110 mg/dl105 mg/dlBUN5-18 mg/dl7 mg/dlCreatinine0.3 – 0.7 mg/dl0.5 mg/dl Ashlee’s orders include: Cefepime 860 mg IV q8 hr. IVF of D5 1/2NS + 20mEq KCL/L @ 60 ml/hr. Tylenol 170 mg po q6 hr prn T > 38.5. Zofran 4 mg IV q8 hr. Morphine 1mg IV prn pain. Transfuse PRBC 1 unit leukopoor, irradiated over 3 to 4 hrs for hgb <7.5. Transfuse platelets 6 units volume reduced, leukopoor, irradiated over 1 hr for platelet count < 15,000.   7. When Ashlee is admitted to your unit, what is the first priority? What will you do first? (Please put in the correct order) ____ IVFs ____ Platelets ____ Packed Red Blood Cells (PRBCs) ____ Cefepime IV 8. Discuss what steps to take before and during any blood transfusion.    9. During her blood transfusion, Ashlee is due for her antibiotic. What should you do?    10. Ashlee's mother approaches you and asks if you can ask the doctor to order some Motrin as she feels it works better for fevers. What should you say? Health Science Science Nursing NURS 236 Share QuestionEmailCopy link Comments (0)