Please help answer the following questions for this casestudy.
Client Profile
Abby is a 4-year-old girl who lives with her parents and twoolder siblings in a suburban environment. She attends preschoolfive mornings a week and enjoys playing with her 5-year-old sisterand 7-year-old brother. She is very active and enjoys playingoutside, riding her tricycle, climbing on the family’s jungle gym,and playing with her imaginary friend, Sophie. Her vocabularyconsists of approximately one thusand five hundred words; shespeaks using five- or six-word sentences, and can recognizeopposites. She is very inquisitive, loves to explore, and asks alot of questions about the world around her. During the week, whileher parents work, Abby and her siblings stay with their grandmotherafter school. In the evenings, the family eats dinner together andmaintains an evening schedule that allows for family play time.
Case Study
During the past 2 months, Abby has been less active than usualand has begun taking one or two naps in the afternoon. Hergrandmother and parents think she looks pale, reasoning that it isbecause of her high activity level, until her interest in goingoutside to play decreases dramatically. She has a low grade feverfor several days that is not controlled by Tylenol. At this point,they decide to take her to see her pediatrician. Although thepediatrician found Abby’s manifestations consistent with an upperrespiratory infection, Dr. Polster is concerned and decided toadmit Abby to the hospital for tests to rule out leukemia.
Her admission vitals are Temperature: 38C (100.4F), Pulse: 120BPM, Respirations: 28 breaths/min, Blood Pressure: 100/60. Abby’sweight is 16.7kg. Her admission complete blood count reveals:
Hemoglobin: 7.8g/dL, Platelet count: 90,000/mm3, White bloodcell counts: 4,000 cells/mm3, Neutrophils: 1,200 cells/mm3,Lymphocytes: 1,200 cells/mm3. A bone marrow aspirate revealedabnormal lymphoblasts in the bone marrow. Thesetests confirm a diagnosis of Acute Lymphocytic Leukemia. Herphysical assessment is unremarkable, other than mild bruising toboth of her legs.
Within48 hours of diagnosis, Abby is taken the OR for placement of achemo port to the left chest wall. Her chemotherapy regimen is thenstarted and the oncologist prescribes Ondasteron 2mg IV prior tochemotherapy and the same dose every 4 hours prn. In addition, sheprescribes Dexamethasone 16mg IV prior to chemotherapy.
Abbyhas been receiving chemotherapy for 3 weeks. Her weight iscurrently 15.1kg. She is refusing all PO intake other thanpopsicles due to nausea and she frequently states her mouth hurts.TPN has just been added to her treatment regimen to infuse for 20hours a day when chemotherapy is not infusing. She has required onePRBC infusion and has received an infusion of platelets on 2occasions. Currently her Hemoglobin is 7.8g/dL, WBC count is 5,000cells/mm3 and platelet count is 100,000/mm3. Her extremitiescontinue to have mild bruising.
Abby’s temperament has been fair, although she continues tosleep most of the day in addition to all night. Almost all of herhair has fallen out. Abby’s mother expresses concern because Abby”has been potty-trained for 2 years, but has wet the bed since shehas been in the hospital”. Abby’s mother has taken a leave ofabsence from her job to stay with Abby in the hospital, whileAbby’s father continues to work and visits Abby and the otherchildren in the evenings. Abby’s siblings are not allowed to visitAbby while she is on the Heme-Onc unit and are being cared for athome by their grandmother. Abby’s mother is often tearful andconstantly making statements such as, “How could this happen to mylittle girl? What can I do to make it go away?”
Use your textbook as a reference for thisproject.
Identify: Identify the developmental stage Abbyis currently in according to her cognitive or psychosocialabilities. List three findings that aid in identifying thedevelopmental stage.
Collect: List accurate, comprehensive, andrelevant assessment data that could be used in determining prioritynursing diagnoses for AFTER Abby’s ALL diagnosis. Your findingsshould be holistic and include both physical (at least 8) andpsychosocial data (at least 6).
Analyze: Analyze the data collected andestablish 4 nursing diagnoses that are prioritized appropriatelyfor Abby. Explain the order of prioritization using the physicaland psychosocial assessment data. Think critically regarding theimpact Abby’s health status has on her individual growth anddevelopment, as well as the entire family dynamics.
Develop: Using your selected nursing diagnoses,state the expected outcome for each diagnosis. List 4 nursinginterventions for each diagnosis.
Evaluate: State your rationale for each nursingintervention selected.
