Medici di Makati College

1601 Noli Santos International Building, Metropolitan Avenue, Makati City

S.Y. 2022-2023
In partial fulfillment of the course requirement in Ospital ng Makati Related
Learning Experiences

A Study On The Care Of A Pediatric Client

Diagnosed with Multiple Pelvic Abdominal Abscess,
Dilutional Hyponatremia, ALL T/C SIADH, T/C
Relapse.

Submitted by:
BSN II - Group 1
GUTIERREZ, Glenda Josh
PADILLA, Lloreine Mae
PALMA, Pauline Ingrid
SAMSON, Prince Adrian
TOUPS, Leynee

Submitted to:
Ms. Jea Bitao, RN
Clinical Instructor

Submitted on June 3, 2023

TABLE OF CONTENTS

Chapter 1 p. 3-6
Introduction p. 3-4
Purpose and Objectives p. 4
Significance and Justification p. 4-5
Scope and Limitations p. 5-6
Background of the Study p. 6
Chapter 2: Review of Related Literature p. 7-10
Chapter 3 p. 11-20
Client Presentation p. 11
Laboratory Results p. 12-14
Nursing Care Plans p. 15-20
Chapter 4 p. 20-21
Chapter 5 p. 21-23
Conclusion p. 22-23
Recommendations p. 23
Sources p. 23-30
Bibliography p. 23-26
Drug Study p. 26-30

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 I. CHAPTER 1

Introduction

According to Hirsch (2021), Acute lymphoblastic leukemia (ALL) happens when the
body makes too many of a white blood cell called a lymphocyte. This is the most common type
of leukemia in children. ALL is also called acute lymphocytic leukemia and acute lymphoblastic
leukemia. ALL can affect different types of lymphocytes called B-cells or T-cells. Acute
lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow — the spongy
tissue inside bones where blood cells are made.

The word "acute" in acute lymphocytic leukemia comes from the fact that the disease
progresses rapidly and creates immature blood cells, rather than mature ones. The word
"lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes,
which ALL affects. Acute lymphocytic leukemia can also occur in adults, though the chance of a
cure is greatly reduced.

According to Cancer.Net (n.d.) “ALL is the most common type of childhood cancer. In
the United States, approximately 75% of people under age 20 diagnosed with leukemia are
diagnosed with ALL. Most cases occur between ages 2 and 5. However, it can be diagnosed at
any age. An estimated 400 people ages 15 to 19 in the United States are diagnosed with the
disease each year.” There is a relatively high survival rate depending on the age group. Children
ages 0 to 14 have a survival rate of 92%, children at ages 15 to 19 have a survival rate of 77%.
These survival rates are meant to measure their survivability after 5 years from their initial
diagnosis or start of treatment, and are only estimates as they describe trends in age groups.

In general, ALL is a cancer that affects mostly the age group of under 20, a type of cancer
that affects the blood and bone marrow, preventing Lymphoblasts from maturing into the B-cells
or T-cells. What makes this case interesting is that the client that will be focused had multiple
complications that arose from ALL such as Hyponatremia, Multiple Pelvic Abdominal Abscess,

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and Multiple Cervical Lymphadenopathies. In the study, it will be explained how the
complications came one by one, and their relation to each other and ALL. These complications
made the case severe enough to be put in the Pediatric Intensive Care Unit (PICU).

Purpose and Objectives

This study aims to find out the appropriate nursing management for Acute Lymphoblastic
Leukemia and the arose complications, Dilutional Hyponatremia, Multiple Pelvic Abdominal
Abscess, Multiple Cervical Lymphadenopathies. More specifically the study seeks to fulfill the
following objectives:

1. Discuss the patients’ development of ALL

2. Discuss the relevant interventions that was utilized to resolve the problem
3. Evaluate the patient’s response to the interventions

Significance and Justification

The purpose of this study is to know the appropriate nursing management of Acute
Lymphoblastic Leukemia and the arose complications. The result of this study is intended to
know if the focus problem and the arose complications have their own treatment. This case study
is essential in benefitting the student nurses, future researchers and caregivers.

TO THE STUDENT NURSES

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 The student nurses that plan to use this study will be benefited as they can use this to
boost their knowledge and skills in analyzing and interpreting the gathered data. This as well
serves as their guide in determining the etiology and how to prioritize the problem that affects
the health of their client in their own case study.

TO THE FUTURE RESEARCHERS

The study was conducted for the benefits of the future researchers that plan to use this
case study as a reference and guide. This will aid them to identify each part of the case and help
them creatively think in a different approach to the topic.

TO THE HEALTHCARE PROVIDERS

This study is important to the caregiver, and future caregivers to patients with similar
cases as what the client of the study focuses on. The study will be going into depth about the
problems and bring to light different treatments that can be done or to be considered.

Scope and Limitations

The study is to determine the appropriate nursing management of Acute Lymphoblastic

Leukemia and the arose complications. This study began from May 18 until June 2. Throughout
that time period, the student nurses have been assigned to the client and have been doing
research on the problem that affected the client through patient charts, and asking the primary
nurses that were assigned to the PICU.

The client is patient Z. J. C. for 2 days, May 22, 2023 and May 23, 2023 the student
nurses conducted an interview on the patient and relative, sister and mother, that accompanied
the client. The client stayed at a tertiary government hospital, in Pedia Main.

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 Some difficulties that were encountered during the data gathering was the complexity and
severity of the case. During the time that the client was selected, he had already had the
complications and other more complications were still being considered by the doctors on shift.
The student nurses also had no prior knowledge about the case and further research was done to
understand what the client was going through. Some information also could not be found in the
patient charts, such as the procedures and treatments that he had gone through. The health history
form was also not found in the charts.

Background of the Study

The study was held in a tertiary government hospital at Makati city, in the Pediatric
Intensive Care Unit (PICU). This is a community hospital that aims to provide excellent and
compassionate services in a cost-effective manner. PICU is a room with multiple beds with
enough personal bed spacing, meant to accommodate multiple intensive care patients. The room
is air conditioned at the right temperature and has the necessary equipment such as their own
exclusive nursing station, e-cart, electrocardiogram (ECG) machine for the client.

This patient was chosen to be the focus of the case study, because of how complex and
severe the problem was. There was also the need to understand the problem of Leukemia as this
has affected one of the relatives of the student nurses, which in turn makes this a crucial study to
understand the treatments and managements.

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 II. CHAPTER II: REVIEW OF RELATED LITERATURE

Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia (ALL) is a cancer in the lymphoid line of the blood cells.
Over 50% of children with leukemia had one or more of five features: a liver one can feel (64%),
a spleen one can feel (61%), pale complexion (54%), fever (53%), and bruising (52%).
Additionally, recurrent infections, feeling tired, arm or leg pain, and enlarged lymph nodes can
be prominent features. B cells and T cells are cells that fight against infection, also called
Lymphocytes. These are matured cells that develop from lymphoblasts. In ALL, it is the
Lymphoblasts that are cancerous. They hinder the development of lymphocytes and increase the
number of defective lymphoid cells.

The cause for lymphoblasts becoming cancerous stems to the bone marrow.
Hematopoietic stem cells are within the bone marrow and they are responsible for generating
Lymphoid lineages, including the Lymphoblasts. These stem cells’ DNA can be damaged by
radiation hence leading to the cancerous Lymphoblasts. ALL can manifest if the person has any
of the following genetic mutations, ARID5B, CDKN2A/2B, CEBPE, IKZF1, GATA3, PIP4K2A
and, more rarely, TP53. These genes play important roles in cellular development, proliferation,
and differentiation, the more gene mutation the person carries, the more significant their risk for
ALL. High levels of ionizing radiation, benzene or previous exposure to chemotherapy can lead
to ALL.

To diagnose for ALL, the following are checked. Complete Blood Count, Electrolytes,
Renal, Lactic Acid Dehydrogenase levels, Chest X-ray for shortness of breath, CT scan of
abdomen and pelvis if there is fullness, tenderness, or mass. Lumbar puncture is done to evaluate
fluid for Lymphoblasts.

To manage ALL, Anthracycline, Vincristine, 1-Asparaginase, and corticosteroids are

given. There is also consolidation therapy, which is a variety of chemo drugs. Maintenance

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therapy is also done, this utilizes oral 6-Mercaptopurine or Methotrexate delivered once weekly
or once monthly. Sign and symptoms of ALL include generalized weakness, anemia, dizziness,
headache, vomiting, lethargy, neck stiffness, cranial nerve palsies, frequent fever and infection,
weight loss, excessive and unexplained bruising, bone pain, joint pain, breathlessness, enlarged
lymph nodes, liver or spleen, Petechiae, which are tiny red spots or lines in the skin due to low
platelet levels, testicular enlargement, and mediastinal mass.

Relationship of Acute Lymphoblastic Leukemia and Dilutional Hyponatremia

Dilutional Hyponatremia is described as Hyponatremia caused by having excess fluids.

The excess fluids causes the sodium to be diluted, hence the Sodium levels will be lowered than
what is considered to be normal (136-145 mmol/L). Hyponatremia is likely to happen to those
that have a slow pace of exercising or a duration of more than 4 hours. Low body weight, female,
excessive drinking of more than 1 L/hr, drugs such as NSAIDs, antidepressants, and diuretics all
contribute to the development of Hyponatremia. However, in the case of Dilutional
Hyponatremia, diuretics is a treatment as there is an excessive amount of fluids that the Kidney
may not be able to excrete due to various reasons such as Syndrome of Inappropriate
Antidiuretic Hormone Release.

ALL produces antidiuretic hormones, specifically the Vasopressin. With the presence of
Vasopressin, the water absorption is regulated which in turn leads to an increased water retention.
In the context of Dilutional Hyponatremia, the water retained leads to the dilution of sodium,
which in turn lowers the sodium levels. In some cases, there will be an abnormal production of
antidiuretic hormones. This is called Syndrome of Inappropriate Antidiuretic Hormone Release,
this is characterized by lower sodium levels and Dilutional Hyponatremia.

Management of dilutional hyponatremia in leukemia involves addressing the underlying

cause, such as treating the leukemia itself or adjusting the dosage of chemotherapy drugs.
Additionally, fluid restriction and administration of hypertonic saline solutions may be necessary
to correct the sodium imbalance.

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Relationship of Acute Lymphoblastic Leukemia and Multiple Cervical
Lymphadenopathies

All over the human body, there are multiple lymph nodes. They serve to protect against
microbes, maintain appropriate fluid levels and adequately absorb nutrients. The lymph nodes
release white blood cells to fight against infection, but when too many white blood cells are sent
out, they may become swollen. Swelling of the cervical lymph nodes does not hurt, however they
can cause discomfort and become tender to touch. This usually happens when there is a throat
infection, common cold, dental problems, ear infection, bronchitis, and eye infection.

Cervical Lymphadenopathy is very common in children, about 38% to 45% children

develop cervical lymphadenopathy. Adults may also have cervical lymphadenopathy, but not as
common as children.

In relation to ALL, the lymphoblasts that are affected are able to infiltrate the lymphoid
lines. Since there is a large accumulation of these lymphoblasts, it leads to the enlargement of
these nodes. ALL weakens the immune system making the client susceptible to infections. These
infections can lead to enlargement of these lymph nodes. According to Osmosis (n.d.)
Generalized lymphadenopathy can be caused by certain cancers such as ALL.

The treatment for multiple cervical lymphadenopathies is usually done by treating the
condition that causes the lymph nodes to enlarge. If the cause is an infection, that said infection
must be remedied in order to treat enlarged lymph nodes. In the context of ALL, the cause of
multiple cervical lymphadenopathies may be connected to ALL, so treating ALL will treat the
cervical lymphadenopathies. However, if the lymph node is damaged, they may be surgically
removed.

Relationship of Acute Lymphoblastic Leukemia and Multiple Pelvic Abdominal Abscesses

An abscess is a buildup of pus under the skin. This is caused by an infection of pathogens
such as bacteria. This buildup of pus will cause the skin to swell and tenderize for 1-2 weeks,

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during that time period fever may develop. The abscess is a mix of immune cells and pathogens
such as bacteria. When dealing with abscess, the pus must be drained by making a small incision
in the skin, because antibiotics alone will not be enough and there is no blood supply to deliver
the antibiotics inside the cavity of the abscess. The drain will leave small amounts of pathogens
in the site of the abscess to allow the body to fight them, and the collected fluid will be used to
determine what kind of bacteria was in the abscess so that the appropriate antibiotic can be
given. An abscess is a buildup that can be visibly seen and felt, ultrasound, CT scans and MRI
can also be used to confirm the abscess. Individuals that have diabetes, skin infections, obesity,
IV drug abuse, and weakened immune system are at a higher risk for developing Abscess.

ALL has no direct relationship to Multiple Pelvic Abdominal Abscesses, but there is an
indirect action being done that leads to the event of buildup of abscesses. As mentioned earlier,
ALL weakens the immune system, this leaves the client at an immunocompromised state and at a
higher risk for infection. This immunocompromise lets pathogens freely buildup under the skin,
creating Abscesses. Treating ALL will not be enough to provide remedy for Multiple Pelvic
Abdominal Abscesses as this complication is not directly affected.

As mentioned earlier, it is suggested to drain the fluid to allow the body to fight the
remaining pathogens, and the fluid collected will be used for examination to pick out the
appropriate antibiotics therapy.

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III. CHAPTER III: Presentation of the Client

PERSONAL DATA:
Patient is J.C.Z. 17 Year-old male, a student from Cavite city. He has an upper self esteem
and is able to feed himself. He practices proper hygiene, and has a full range of motion. He
enjoys playing Basketball and Videogames. Before hospitalization, he was active in exercise. He
is able to sleep without difficulty, and as a regular pattern of elimination. Food preferences are
Sabaw (Sinigang), Takbet, Tage, Adobo and Isda. His eating habits are eating 1 cup of rice, 3
times a day. He can speak English and Tagalog, and was accompanied by his sister and mother
throughout the duration of the stay.

CHIEF COMPLAINT:
"Nilalagnat, sumakit, nakirot yung tiyan, matigas, malalim yung pain, tumatagal yung
sakit ng 30 mins, dahil nakahiga, pinahiram ng mansanilia. Pag naglalakad hindi na sumasakit"

PHYSICAL EXAMINATION:
He undergone physical examination procedure which shows that the patient is patent non
hyperemic EAC, intact ™ bilateral nasal septum midline, pink non-boggy turbinates non asses,
non erythematous, non erythematous posterior pharyngeal wall supple neck, trachea midline
multiple sub centimeter CLADS on bilateral levels IV and V lymph node levels + axillary
lymphadenopathies, bilateral.

ENVIRONMENT HISTORY:
The patient’s home is rented with one comfort room, which is water sealed. Their water
supply is MWSS, and their garbage gets collected. They have electricity at home and their means
of transportation is public. For community resources, they make use of the Church, Mall, Sports
facilities, and School

HOSPITALIZATION
Patient was hospitalized at Trese for Abdominal pain from April 28, and was transferred
to Makati city at a tertiary government hospital 2 days after being admitted in Trese.

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 The Patient was last seen on June 2, 2023. The patient’s health improved and the chief
complaint, which is abdominal pain, has now disappeared and there is no expression of
discomfort or verbalization of pain which is a good indication of the patient's health
improvement.

Laboratory Results:
Format:
Date Received (Day requested)
M/DD (DD)

5/05 (04) Result Measurement High or Low NORMAL VALUES

Protothrombin Time 14.3 seconds H 10.4-14

% Activity 71.7 % L 73-127

INR 1.122 H 0.88-1.12

PARTIAL
THROMBOPLASTIN
TIME

Activated PTT 43.6 seconds H 30.4 - 41.2

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5/12 (12) Result Measurement High or Low NORMAL VALUES
Protothrombin Time 16.2 seconds H 10.4-14
% Activity 56.5 % L 73-127
INR 1.4 H 0.88-1.12
PARTIAL
THROMBOPLASTIN
TIME

Activated PTT 53.7 seconds H 30.4 - 41.2

5/17 (16) Result Measurement High or Low NORMAL VALUES

Protothrombin Time 16.3 seconds H 10.4-14
% Activity 55.8 % L 73-127
INR 1.41 H 0.88-1.12
PARTIAL
THROMBOPLASTIN
TIME

Activated PTT 43.6 seconds H 30.4 - 41.2

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5/04 (04) Result Measurement High or Low NORMAL VALUES
Hemoglobin 9.7 g/dL L 14-18
Hematocrit 0-28 L 0.4-0.54
WBC 15.5 x10^9 / L H (4-11)
RBC 4.1 x10^12 / L L 5-6.4
Platelet Count 225 x10^9 / L - 150-450
Mean Cell Volume 68.3 fL L 80-96
Mean Cell
Hemoglobin 23.6 pg L 27-31
Mean Cell
Hemoglobin
Concentration 34.6 g/L - 32-36
Mean Platelet
Volume 7.4 fL - 6.5-12
Red Cell
Distribution Width 12.7 % - 11.6-14.6
DIFFERENTIAL
LEUKOCYTE
COUNT
Segmenters 87 % H 50-70
Lymphocyte 6 % L 20-40
Monocyte 7 % H (2-5)
IMMUNOLOGY
C-Reactive Protein > 10 mg/L - 0-3

5/10 (09) Result Measurement High or Low NORMAL VALUES

Sodium 127.11 mmol/L L 136-145
Potassium 4.28 mmol/L - 3.5-5.1
Chloride 99.02 mmol/L - 98-107

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5/17 (16) Result Measurement High or Low NORMAL VALUES
Sodium 125.46 mmol/L L 136-145
Potassium 3.78 mmol/L - 3.5-5.1
Chloride 95.43 mmol/L L 98-107

5/05 (04) Result Measurement High or Low NORMAL VALUES

Sodium 130.91 mmol/L L 136-145
Potassium 3.28 mmol/L L 3.5-5.1
Chloride 98.68 mmol/L - 98-107

5/06 (04)
RBC Mild microcytic hypochromic anemia
WBC No abnormal
Platelet Adequate

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NURSING CARE PLAN:

● The Patient will be able to display laboratory results within normal range. Normal
laboratory results which aim to restore the electrolyte balance, improve the patient’s
blood pressure, and ultimately promote the patient’s overall health and well-being.
Normal laboratory results would be an indication of successful treatment.

● The Patient will not show any signs of discomfort associated with pain. The aim is to
relieve the patient’s pain, improve their comfort, promote their recovery, and enhance

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 their overall well-being. The absence of signs of discomfort is a potential outcome of
effective pain management.

● The Patient’s risk for confusion will be lessened. Having the relatives or SO engage in
the interventions will help the patient remain calm as there will be the sense of
familiarity, and monitoring for the mental status will help determine immediately the
status of the patient for a timely needed intervention.

● The Patient’s risk for activity intolerance will be lessened. The patient will be put into
light exercises under safety measurements made by the nurse to help the patient recover
and enjoy without worrying about their risk of injury or discomfort.

NDX1: Electrolyte Imbalance r/t excessive fluid in the body as evidenced by low values of
Sodium in serum electrolyte

Goal: After 4 hours of nursing intervention, the patient will display laboratory results within
normal range

Interventions:
1. Assess mental status, noting client/caregiver report of change-alteration span, recall of
events, and other cognitive functions.
2. Monitor heart rate and rhythm by palpation and auscultation.
3. Auscultation breathing Sounds, assess rate and depth of respirations and ease of
respiratory effort, observe color of nail beds and mucous membranes, and note pulse.
4. Review laboratory results for abnormal findings.

Rationale:
● This can be associated with electrolyte imbalance; for example, it is the most common
sign associated with sodium imbalances.
● Tachycardia, bradycardia, and other days rhythmically are associated with potassium,
calcium, and magnesium imbalances.
● Certain electrolyte imbalances, such as hypokalemia, can cause or exacerbate
respiratory insufficiency.
● Because the ECG reflects electro physiological, anatomical, metabolic, and
hemodynamic alterations, it is routinely used for the diagnosis of electrolyte and

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 metabolic disturbances, as well as myocardial ischemia, cardiac dysrhythmias,
structural changes of the myocardium, and drug effects.
● Electrolytes include sodium, potassium, calcium, chloride, bicarbonate (carbon
dioxide), and magnesium. These are essential in many bodily functions including fluid
balance, movement of fluid within and between body compartments, nerve conduction,
muscle contraction - including the heart, blood clotting, and pH balance. Excitable
cells, such as nerve and muscle, are particularly sensitive to electrolyte imbalances.

Evaluation:
The patient will be able to be free from complications resulting from electrolyte imbalances

NDX2: Risk for acute confusion r/t electrolyte imbalance

Goal: After 4 hours, family members verbalize understanding of disease process and prognosis
and the patient’s needs, recognize and engage in interventions to deal completely with the
situation

Interventions:
1. Review current medication regimen
2. Consult significant others about client's usual behavior and mental status
3. Provide calm environment
4. Be supportive
5. Maintain reality-oriented relationship and environment

Rationale:
● Adverse drug reactions may potentiate or exacerbate confusion
● Provide baseline for comparison with current status
● This is to minimize and eliminate noise that may increase level of agitation/confusion
● When the client is attempting to communicate, be sensitive and listen to them with
interest and respect, by that you are building trust and may help in decreasing
confusion and fear
● So that the patient feels that he is included and not out of place cells, such as nerve and
muscle, are particularly sensitive to electrolyte imbalances.

Evaluation:
The family members or significant others have been able to verbalize their understanding in
the disease process and prognosis, and engaged in interventions to deal with the situation

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NDX3: Acute Pain r/t biological injury agent as evidenced by pain scale of 8/10

Goal: After 4 hours of nursing intervention, the patient will not show any signs of discomfort
associated with pain.

Interventions:
1. Determine and document presence of possible pathophysiological causes of pain.
2. Assess for referred pain, as appropriate
3. Evaluate pain characteristics and intensity.
4. Perform pain assessment each time pain occurs. Document and investigate changes
from previous reports and evaluate results of pain interventions.
5. Accept client’s description of pain. Be aware of the terminology client uses for pain
experience.

Rationale:
● Acute pain is that which follows an injury, trauma, or procedure such as surgery, occurs
suddenly with the onset of a painful condition,
● To help determine the possibility of underlying condition or organ dysfunction
requiring treatment.
● Use pain rating scale appropriate for age and cognition, adolescent pediatric pain tool,
pain assessment scale for seniors with limited ability to communicate; behavioral pain
scale; checklist of nonverbal pain indicators.
● To demonstrate improvement in status or to identify worsening of underlying
condition/developing complications.
● Pain is a subjective experience and cannot be felt by others.

Evaluation:
The patient will be able to prevent signs of discomfort associated with pain.

NDX4: Risk for Activity Intolerance r/t sedentary lifestyle

Goal: After 4 hours of nursing intervention, the patient’s tolerance to activities will be
increased

Intervention:
1. Promote comfort measures and provide for relief of pain
2. Encourage ambulation and light exercises
3. Plan care with rest periods between activities
4. Provide appropriate nutritional supplements as indicated
5. Increase exercise activity levels gradually

Rationale:
● To enhance ability to participate in activities

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 ● This is to minimize the feeling of weakness and prevent atrophy
● To reduce fatigue
● This is to improve the client's physiologic state through nutrition
● This is so that the patient will gradually improve their physiologic state.

Evaluation:
The patient will be able to walk around and not verbalized any assistance in activities

IV. Chapter IV: Analysis and Interpretation

Low values of electrolyte which is 125.46 mmol/L which shows that the patient has
electrolyte imbalance. This imbalance is a sign of a problem like a kidney disease. Patient
experienced vomiting as a previous symptom before admitting inside the hospital. The patient
undergoes blood and urine tests in order to identify the electrolyte findings. Patient’s laboratory
results for electrolytes are; sodium (125.46mmol/L) which is lower from the normal range,
Potassium (3.78 mmol/L) within the normal range, Chloride (95.43mmol/L) is lower than the
normal range. The laboratory result indicates that the patient has this condition which is also
known as hyponatremia.

The patient had experienced severe abdominal pain with a pain scale of 8/10 as
verbalized by the patient, which shows that the patient had experienced severe abdominal pain
upon admission in the hospital. Last May 18, 2023 when taking the vital signs, the patient's
temperature exceeded the normal range which is 39°C or also known as hyperthermia. The
patient's abdomen is showing mild swelling which causes discomfort or tenderness in the
abdomen (RUQ) and verbalization of pain by the patient. The patient was given 300mg
paracetamol (Neocetamol) through IV QID in order to treat hyperthermia which is related to a
biological injury agent secondary to infection.

The patient has built activity intolerance related to generalized weakness as evidenced by
fatigue. Upon entering the patient’s room, the patient is lying on his bed covered from chest to
feet. awake and accompanied by his sister, upon checking his vital signs of 25 breathe per minute
respiratory rate, 89 beats per minute Pulse rate, 100/70 millimeters of mercury, 99 percent

20
oxygen saturation, and 39 degrees celsius body temperature. The patient was not in an IV and not
in an oxygen cannula, there was no shown wound or swelling. When asked if the patient was
okay, he was only nodding his head, but he looked pale and weak. The student nurses advised
him to take a nap if he desires and put him in a more comfortable position. Taught deep
breathing exercises.

Risk for activity intolerance related to sedentary lifestyle. Patient Z.J.C. stayed in bed
from the beginning of the admission, and did not move around much. When the client did move
however, they had sluggish movements and were always assisted by the relative presently
accompanying them.

V. Chapter V : Summary of Findings

This study aims to find out the appropriate treatments and management for Acute
Lymphoblastic Leukemia and the arose complications, Dilutional Hyponatremia, Multiple Pelvic
Abdominal Abscess, Multiple Cervical Lymphadenopathies. In this section of the case study, the
questions that were sought to be answered will be addressed:

Objective 1: Discuss the patients’ development of ALL

The patient had Leukemia back in his previous years. It is believed that due to the
treatment he had undergone, his current Leukemia relapsed from it. In turn, his condition
worsened as his Leukemia was left unchecked until the patient came to check for his abdominal
pain.

Objective 2: Discuss the relevant interventions that was utilized to resolve the problem

Treatments and management on the complications can be done separately. Such as

Dilutional Hyponatremia needing to be treated on its own as it becomes a problem that cannot be
corrected through treatment of secondary conditions. However, it is important to take note of
treatments through drug therapy as there may be possible drug interactions with one another.

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Objective 3: Evaluate the patient’s response to the interventions

The interventions done by nurses on duty were all to prevent future complications,
potential problems, and to alleviate any of the patient’s discomfort. In response to it, the patient
has been slowly regaining health and strength throughout the 1 month of stay.

Conclusion

Acute Lymphoblastic Leukemia was the main source of the problem. The client
previously had Leukemia back in 2011, treated through chemotherapy. As explained in the
related literature, one of the causes of ALL is the damaged DNA of the cells. In the context of
the client, the chemotherapy attacks the normal healthy cells. Some that survived became
cancerous which brought about the relapse of Leukemia. This affected the bone marrow and in
turn the development of the ALL. With that now present, complications arose. Dilutional
Hyponatremia as evidenced by the client’s vomiting, this may be secondary to Syndrome of
Inappropriate Antidiuretic Hormone Release because of the confirmation of ALL. The client’s
abdominal pain must have been from the buildup of abscesses in the pelvic abdominal area, this
is because of their weakened immune system from the presence of ALL. The multiple cervical
lymphadenopathies may have been from two possible things, infection or the cancerous
lymphoblasts invading the lymph nodes.

The treatment of the client took a whole month, due to the severity and complexity of the
case as well having to do multiple testing to determine the true problem. The client’s willingness
to be treated was one of the factors that helped meet the needs of the patients. Patient Z. J. C. was
cooperative towards the healthcare providers which helped prevent the further complications
from developing. The primary nurses that were assigned to PICU were competent in their job,
keeping a watchful eye on the client with the help of the student nurses taking the client’s vital
signs every hour and the fast relay of information for any findings that are unusual. The quick
and timely confirmation and intervention for when those unusual findings arise also contributed
to the recovery of the client

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Recommendations

It is recommended that when coming up with the nursing management of the patient,
there must be consideration in the client’s opinion whether they want to push through with the
plan or not. There must be emphasis on the infection precaution as clients with Acute
Lymphoblastic Leukemia are at high risk of obtaining infection. To handle clients that may have
a case of ALL and different complications, it is recommended that the caregiver should educate
themselves on the complications as they need to be approached at a different perspective and
cautious of the management given as it may further harm than help. Lastly, be observant of the
client. They may not feel anything wrong, but the findings could say otherwise. The caregiver is
recommended to study what the unusual findings are that are specific to the case on their hand.

SOURCES
1. American Society of Clinical Oncology. (n.d.). Leukemia—Acute
Lymphoblastic—Childhood: Statistics. Cancer.Net. Retrieved June 3, 2023, from
https://www.cancer.net/cancer-types/leukemia-acute-lymphoblastic-all-childhood/statistic
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phadenopathy

APPENDIX:

Drug Study

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