Acute Lymphoblastic Leukemia

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Scenario: Acute Lymphoblastic Leukemia (ALL)
An 11-year-old boy is brought to the clinic by his parents who state that the boy has not been eating and is listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes.

The mother states the child has had intermittent fevers that respond to acetaminophen.
Maternal history negative for pre, intra, or post-partum problems.
PMH: Negative. Easily reached developmental milestones.
PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern.
LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl.
DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents.
CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing.

Question:
Explain what ALL is?

Why does ARF occur in some patients with ALL?

Good nonpharmacologic treatment for pain

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Somatosensory Function, Pain, Headache, and Temperature Regulation
CASE STUDY:
Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches.
Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. It was not until her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from the temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts.
In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.
QUESTIONS:
What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?
Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?
Using your knowledge of physiology, how do NSAID analgesics function in the management of pain?

The multiaxial diagnostic assessment

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DSM-5 gives an appendix of information about multicultural aspects of diagnosis. It is divided into two sections. The first section is an “outline for cultural formulation” that is intended to supplement the multiaxial diagnostic assessment and to address complexities that arise when applying DSM-5 criteria in a multicultural environment.

It systematically reviews peoples’ cultural backgrounds, the role of the cultural context in symptomatology, and also cultural differences between the patient and clinician. The second section is a glossary of “culture-bound syndromes.” For instance, Hwa-Byung (also known as wool-Hwa-Byung) is a Korean folk syndrome attributed to the suppression of anger. Its symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric effect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the upper middle region of the abdomen.

Explain how culture affects what is considered normal and abnormal, and describe one different culture-specific disorder using the attached reference list.

The NLN scope of practice

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Discuss the value of a professional career portfolio which includes a teaching philosophy, a curriculum vitae (expanded resume), samples of publications and writings, proof of competencies, etc. Describe how you plan to organize your portfolio, how you plan to distribute it to potential employers, what you plan to include in it and what type of educator role you would seek.
Consider the NLN scope of practice, what practice standards do you already feel comfortable/competent at performing, and which ones do you need to work towards accomplishing; how and why?

Effectiveness of alternative and complementary medicine

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Discuss the safety and effectiveness of alternative and complementary medicine for the treatment of specific illnesses such as cancer, diabetes, and hypertension. Would you have any conflicts/concerns supporting a patient who chooses holistic/allopathic medicine?

Advantages of breastfeeding for mothers

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Create an advertising campaign to raise awareness of the advantages of breastfeeding for mothers and babies. Discuss three reasons why a woman should or should not breastfeed and examine the effects of certain diseases and medications on breast milk. How will you as a nurse encourage breastfeeding? Examine infant feeding practices of a cultural group that is different from yours and describe the beliefs and practices concerning the feeding method, care of the mother, and infant. How does this culture compare with the current recommendations of the American Academy of Pediatrics related to infant feeding?

Policies that influence population health

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For the Week 1 discussion, consider a topic that rose to the presidential level. How did each of the past presidents (Trump, Obama, and Bush) handle the problem? What would you do differently? Try to learn how the issue became part of each president’s agenda.
Post your response on or before Day 3. Be sure to support your response with a minimum of 3 scholarly and recent sources to earn full credit.
All references must be cited within the response.

“Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?

Reference:
New York State Department of Health. (n.d.). Making New York the healthiest state: Achieving the triple aim. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf

To Prepare:

Review the Resources and reflect on the importance of agenda-setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.”

Differentiate between systolic and diastolic heart failure

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Differentiate between systolic and diastolic heart failure

Systolic heart failure is congestive heart failure with reduced ejection fraction (HRrEF), less than 40%, and is defined as the inability of the heart to perfuse adequately to cell tissue, due to decreased cardiac output (McCance & Huether, 2019). Heart rate and stroke volume are influenced by contractility, preload, and afterload affecting cardiac output, decreasing contractility with disturbances in myocyte activity. Ultimately, decreasing stroke volume and contractility while increasing left ventricular end-diastolic volume, and increasing preload.

Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF) can occur along with systolic heart failure, or alone, and is most commonly caused by persistent hypertension-induced myocardial hypertrophy, and myocardial ischemia causing ventricular remodeling along with higher diastolic pressure (Gazewood & Turner, 2017). Impaired relaxation is the result of decreased ability of myocytes to pump calcium from cytosol manifesting from ischemia and hypertrophy (McCance & Huether, 2019). As well as, decreased compliance of the left ventricle and abnormal diastolic relaxation. More common in females, patients with diastolic dysfunction present with dyspnea on exertion, fatigue, S3 heart sounds, and pulmonary edema

State whether the patient is in systolic or diastolic heart failure.

Due to the patient’s ejection fraction of 25%, the patient is in systolic heart failure. The clinical presentation of the patient also leads to systolic heart failure with the 3rd heart sound noted, commonly caused by atrial pressure, edema to the lower extremities caused by decreased cardiac output, dyspnea, and crackles as a result of pulmonary edema due to insufficient blood flow resulting in the congestion of blood in the lungs, as well as jugular vein distention. The patient’s past medical history of hypertension, hyperlipidemia, and type 2 diabetes contributes to the likelihood of systolic heart failure.

Explain the pathophysiology associated with each of the following symptoms

A common symptom of heart failure, shortness of breath occurs due to the decreased ability to maintain left ventricular pressure and contractility, resulting in chronic back pressure of blood into the left atrium with backflow into the pulmonary veins, creating elevated pressures in the vessels around the lung, and congestion in the lungs. Clinical presentation of this includes shortness of breath, anxiety, cough with blood-tinged mucus, and respiratory crackles on auscultation. Pitting edema in the lower extremities is caused by an excess fluid build-up, venous insufficiency, and the heart’s inability to pump blood throughout the body. In this patient’s case, with an ejection fraction of 25%, the left ventricle is unable to meet the demands of blood flow for the body, resulting in the pooling of blood and fluids in the lower extremities. Increased pressure in the right atrium results in backflow of blood flow manifesting as jugular vein distention. Similar to the shortness of breath that occurs during exertion, orthopnea is the presence of difficulty breathing while lying flat. The result of this is due to the backflow of blood into the lungs, as a result of a decreased ejection fraction and pulmonary congestion due to ventricular failure and increased filling (McCance & Huether, 2019).

Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%

Ejection fraction measures the percentage of blood that leaves your heart with every contraction, ejecting blood from each of the two ventricles (mayoclinic.org, n.d). The left ventricle is the body’s main pumping chamber, and as the ejection fraction decreases so does the heart’s ability to supply oxygen-rich blood through the aorta and to the rest of the body. An ejection fraction of lower than 40% or less results in ventricular heart failure. Abnormal or extra heart sounds reflect left ventricular dysfunction (McCance & Huether, 2019). The 3rd heart sound occurs in diastole at the end of the filling of the ventricles, as seen in heart failure patients due to rapid ventricular distention, and increased atrioventricular flow (Shono et al,

Knowledge of healthcare operational planning and management

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Week 8 Discussion Question- Reflection
Please share what specific knowledge of healthcare operational planning and management that you gained through this experience will be most important as you take on your future nurse executive role?

How will you use the concepts in this course to identify, guide, and evaluate your final MSN practicum project? Please share your topic or idea for your practicum project if you have one identified. ( I don’t have one yet). Review the ANCC nurse executive board certification examination test content outline. Share how becoming certified can benefit you, in your role as a nurse leader.

Chronic obstructive pulmonary disease

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Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1 ; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practi