Question

Case Study, Chapter 12, Assessing Spirituality and Religious Practices

A 52-year-old client is in the terminal stage of leukemia. The client has been married for 25 years. He and his wife have three children, ages 15, 18, and 22. One child is graduating from high school, and the 22 year old is graduating from college. The client and his brother are co-owners of a family hardware business that has been in the family for 60 years. The client was diagnosed with leukemia 10 years ago and has been receiving treatments during reoccurrences since then. He has always been optimistic, but, for the last 2 years, the treatments have not been as successful as in the past. His symptoms have exacerbated and return shortly after the treatments. The physician has told him that, unfortunately, further treatments are to no avail. The client is distressed and in denial of the fact that life is short. He has become depressed because he is concerned about what will happen to his family and his business. The client does not want to visit family members or friends. He has always been a firm believer in God and believes that the illness is God’s punishment for wrong deeds. While trying to reassure the client, the nurse tells him that God does not punish.

Based off this cased study answer the following

1) identify subjective data & objective data

2)identify cue clusters

3) Draw inferences

4) List possible nursing diagnoses

5) check for defining characteristics

6)confirm or rule out diagnoses

7) Document Conclusions

-Nursing diagnoses that are appropriate for this client include:

-potential collaborative problems include :

Answer 1

Ans

1)

Subjective Data:

• Loss of appetite, weight loss
• Tendency to bruise or bleed
• Fatigue, weakness
• Bone pain

Objective Data:

• Frequent infections
• Fever
• Swollen lymph nodes
• Enlarged liver / spleen
• Petechiae
• Recurrent nosebleeds
• Prolonged clotting factors
• Elevated WBC
• Pallor

2) A spatial cluster of acute lymphoblastic leukaemia was detected using the pregnancy address (p <0.05). The most common environmental risk factors related with the aetiology of acute lymphoblastic leukaemia, identified by the Paediatric Environmental History were: prenatal exposure to tobacco (75%) and alcohol (50%); residential and community exposure to pesticides (62.5%); prenatal or neonatal ionizing radiation (42.8%); and parental workplace exposure (37.5%)

3) It has been associated with long-term or late effects, including infertility, thyroid dysfunction, chronic fatigue and risk for developing a second cancer (lymphoma; melanoma of the skin; or cancer of the tongue and salivary glands, central nervous system, bone, soft tissue and thyroid gland).

4) Nursing diagnosis -

• Initiate bleeding precautionsappropriatel
• Assess and manage pain apprappropriately
• Monitor for signs / symptoms of infection or sepsis
• Promote normothermia
• Anticipate needs
• Monitor Intake & Output and signs/symptoms of dehydration
• Patient and family education
• Avoid risk of infection from procedure
• Promote self care, independence and ADLs

5 )

• Initiate bleeding precautions

Clotting factors are impaired and patients are at a higher risk of bleeding and bruising

• Assess and manage pain appropriately
  • Massage
  • Positioning
  • Cool/heat therapy
  • Aromatherapy
  • Guided imagery
  • Medications as necessary

Pain can be difficult to control and manage and medications may be scheduled with PRN measures for breakthrough pain. Make sure the intervention is appropriate for the patient and avoid extra stressors such as movement. Encourage patient to try non-pharmacological interventions and balance those with medication for more comprehensive pain control.

• Monitor for signs / symptoms of infection or sepsis

Especially during treatment, patients are at higher risk of developing sepsis. Monitor closing for signs and symptoms and notify MD as necessary.

• Promote normothermia

Progressive hyperthermia may occur as the body’s response to disease and effects of treatment. Monitor temperature closely, especially during chemotherapy.

• Anticipate needs

Time pain and nausea medications at their peak according to therapy, chemo and meal times to increase their effectiveness

• Monitor Intake & Output and signs/symptoms of dehydration
  • Skin turgor
  • Dry mucous membranes
  • Capillary refill

Dehydration and kidney compromise is a potential complication of disease and treatment. Encourage hydration and monitor closely.

• Patient and family education
  • Symptoms and disease process
  • Infection prevention
  • Plan of care

Patients and family members must be knowledgeable of process and what to expect to help reduce anxiety and be prepared for complications as they arise. Educate family members and caregivers of the importance to help reduce risk of infection for the patient by practicing good hand hygiene.

• Avoid risk of infection from procedures:
  • Foley catheter insertion
  • Injections
  • Lines and tubes

Lack of sufficient white blood cells damages the immune system and patients are more prone to infections. Weight risk versus benefit.

• Promote self care, independence and ADLs

Fatigue is a common symptom and can prevent the patient from participating in self care. Provide assistance with ADLs as needed and cluster care to reduce fatigue and promote rest. Prioritize activities to help conserve energy for self care.